Healthcare Provider Details

I. General information

NPI: 1487462347
Provider Name (Legal Business Name): JENISA KRAMER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 PLANTATION RIDGE DR STE 190
MOORESVILLE NC
28117-9178
US

IV. Provider business mailing address

5833 CIRCLEWOOD DR
KANNAPOLIS NC
28081-8736
US

V. Phone/Fax

Practice location:
  • Phone: 800-809-1265
  • Fax:
Mailing address:
  • Phone: 585-808-2346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08240966
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: