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General NPI Number Information
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NPI Number | 1144550922
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Entity Type | Individual
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Provider Name | JESSICA MARIE MCCARTHY C.R.N.P.
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Gender | Female
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Dates
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Enumeration Date | 12/30/2009
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 15125 22 MILE RD
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City | SHELBY TWP
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State | MI
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Zip | 48315-4406
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Country | US
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Telephone | 586-532-0599
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 CEDARHILL DR
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City | ROYAL OAK
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State | MI
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Zip | 48067-1287
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Country | US
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Telephone | 267-994-0021
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 24171050501
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License Number State | MI
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