Provider Demographics
NPI:1003220518
Name:HAGLEY, JESSICA LAUREN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LAUREN
Last Name:HAGLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LAUREN
Other - Last Name:DEL VECCHIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9121 SAM FURR RD STE 108
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8235
Practice Address - Country:US
Practice Address - Phone:704-324-3590
Practice Address - Fax:704-324-3591
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006930363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2818Medicaid
NC1003220518Medicaid
NC268791OtherNC MEDICAID LICENSE
NC1003220518Medicaid
NCNCJ835AMedicare PIN