MEDICARE: JENNIFER HUDSON WEISNER NP

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	363LP0200X	Pediatric Nurse Practitioner	5001562	NC
2	363L00000X	Nurse Practitioner	5001562	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487675534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HUDSON WEISNER NP

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-384-7840
Fax Number	:	704-384-7830

Provider Business Practice Location Address
First Line	:	301 HAWTHORNE LN
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2450
Country	:	US
Telephone Number	:	704-384-1900
Fax Number	:	704-384-1919

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	09/11/2025

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