Healthcare Provider Details

I. General information

NPI: 1477432102
Provider Name (Legal Business Name): JESSICA ANANDA FISHER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PAVILION WAY
SOUTHERN PINES NC
28387-4561
US

IV. Provider business mailing address

200 PAVILION WAY
SOUTHERN PINES NC
28387-4561
US

V. Phone/Fax

Practice location:
  • Phone: 910-235-3330
  • Fax: 910-235-3400
Mailing address:
  • Phone: 910-235-3330
  • Fax: 910-235-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5022955
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: