Healthcare Provider Details

I. General information

NPI: 1073448882
Provider Name (Legal Business Name): JESSICA NICOLE EDDINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 RENAISSANCE DR
PITTSBORO NC
27312-0980
US

IV. Provider business mailing address

1318 OLD SANFORD RD
MONCURE NC
27559-9225
US

V. Phone/Fax

Practice location:
  • Phone: 919-542-3626
  • Fax:
Mailing address:
  • Phone: 919-548-6269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4614
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: