Healthcare Provider Details

I. General information

NPI: 1336073907
Provider Name (Legal Business Name): JESSICA CHARLENE BILLUPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 SOUTHERN AVE
RAEFORD NC
28376-3272
US

IV. Provider business mailing address

1233 GREENBRIAR DR
VASS NC
28394-9201
US

V. Phone/Fax

Practice location:
  • Phone: 910-565-0622
  • Fax: 910-406-1069
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: