Healthcare Provider Details

I. General information

NPI: 1487549176
Provider Name (Legal Business Name): JERRI LYNN MUSSELWHITE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 THREE HUNTS DR
PEMBROKE NC
28372-8998
US

IV. Provider business mailing address

6604 RUNNING FOX RD
HOPE MILLS NC
28348-2930
US

V. Phone/Fax

Practice location:
  • Phone: 910-522-0408
  • Fax: 910-338-1515
Mailing address:
  • Phone: 910-874-0998
  • Fax: 910-338-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5022253
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: