=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255604013
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYME L KRESSEN AGNP-C, RN, CSA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2012
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 PLANK BRIDGE RD CT UNIT B
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27921-7025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-331-1829
-----------------------------------------------------
Fax | 252-331-2916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 PLANK BRIDGE RD CT UNIT B
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27921-7025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-331-1829
-----------------------------------------------------
Fax | 252-331-2916
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 339008
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 246ZC0007X
-----------------------------------------------------
Taxonomy Name | Surgical Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 339008
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------