Healthcare Provider Details

I. General information

NPI: 1508412511
Provider Name (Legal Business Name): JESSICA RAKES HEYSE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 CARTHAGE ST
SANFORD NC
27330-4162
US

IV. Provider business mailing address

614 LONGLEAF RD
ABERDEEN NC
28315-2126
US

V. Phone/Fax

Practice location:
  • Phone: 919-774-2100
  • Fax:
Mailing address:
  • Phone: 540-493-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012161
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5012161
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: