Healthcare Provider Details

I. General information

NPI: 1215866595
Provider Name (Legal Business Name): JAMMIE LORENZ FERRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 JAKE ALEXANDER BLVD W
SALISBURY NC
28147-1213
US

IV. Provider business mailing address

510 FORD ST
KANNAPOLIS NC
28083-5073
US

V. Phone/Fax

Practice location:
  • Phone: 704-645-8539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number181107
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: