Healthcare Provider Details

I. General information

NPI: 1790118743
Provider Name (Legal Business Name): JODY FRANCIS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 EDWARDS MILL RD STE 141
RALEIGH NC
27612-5371
US

IV. Provider business mailing address

7614 PONTCHARTRAIN RD
WILMINGTON NC
28412-3141
US

V. Phone/Fax

Practice location:
  • Phone: 919-443-2360
  • Fax: 919-800-3039
Mailing address:
  • Phone: 910-350-8252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number198736
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: