MEDICARE: JESSICA LYNN HAINES

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	363L00000X	Nurse Practitioner	F01261066	NC
2	163WM0705X	Medical-Surgical Registered Nurse	292724	NC

General Provider Information

NPI Number	:	1952275240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LYNN HAINES

Provider Business Mailing Address
First Line	:	1638 OWEN DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3424
Country	:	US
Telephone Number	:	910-615-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 WALSH PKWY STE 100
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-1642
Country	:	US
Telephone Number	:	910-491-2744
Fax Number	:

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

Provider Enumeration Date	:	10/01/2025
Last Update Date	:	01/29/2026

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