Healthcare Provider Details

I. General information

NPI: 1053779504
Provider Name (Legal Business Name): JESSICA RISPOLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 E 12TH ST
WASHINGTON NC
27889-3409
US

IV. Provider business mailing address

111 RIVERVIEW DR
WASHINGTON NC
27889-9763
US

V. Phone/Fax

Practice location:
  • Phone: 252-975-4100
  • Fax:
Mailing address:
  • Phone: 610-334-2667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015900
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5010078
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: