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General NPI Number Information
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NPI Number | 1457003865
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Entity Type | Individual
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Provider Name | JACKIE SHORTER PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/26/2022
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 2565 RAVENHILL DR STE 2C
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5414
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Country | US
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Telephone | 910-864-1799
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Fax |
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Provider Business Mailing Address
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Address Line | 1822 ELLIE AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-8526
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Country | US
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Telephone | 910-309-0866
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2021102013
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5016089
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License Number State | NC
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