Healthcare Provider Details

I. General information

NPI: 1528719747
Provider Name (Legal Business Name): JESSICA MARGIE LEE MCCAIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PROFESSIONAL PARK
GAFFNEY SC
29340-2319
US

IV. Provider business mailing address

111 E THIRD AVE
GASTONIA NC
28052-4317
US

V. Phone/Fax

Practice location:
  • Phone: 864-489-1446
  • Fax: 864-489-4909
Mailing address:
  • Phone: 704-874-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016937
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: