MEDICARE: JESSICA BARRY PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5011409	NC
2	363LP2300X	Primary Care Nurse Practitioner	5011409	NC
3	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	5011409	NC

General Provider Information

NPI Number	:	1104382639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BARRY PMHNP

Provider Business Mailing Address
First Line	:	10901 WORLD TRADE BLVD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-4203
Country	:	US
Telephone Number	:	919-746-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	10901 WORLD TRADE BLVD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-4203
Country	:	US
Telephone Number	:	919-746-8900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2019
Last Update Date	:	01/18/2026

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