1225591118 NPI number — MRS. JESSICA NICOLE WILBURN NP-C

Table of content: MRS. JESSICA NICOLE WILBURN NP-C (NPI 1225591118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225591118 NPI number — MRS. JESSICA NICOLE WILBURN NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILBURN
Provider First Name:
JESSICA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
JESSICA
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225591118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8222 HIGH PINE CHURCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27205-8530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-460-0536
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 W SALISBURY ST STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27203-5498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-636-5100
Provider Business Practice Location Address Fax Number:
336-636-5144
Provider Enumeration Date:
04/09/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  5011633 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com