Provider Demographics
NPI:1114937224
Name:CARTER, JESSICA PITTS (NP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:PITTS
Last Name:CARTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:PITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:445 DOLLEY MADISON RD STE 410
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-5167
Mailing Address - Country:US
Mailing Address - Phone:336-292-1510
Mailing Address - Fax:336-292-0679
Practice Address - Street 1:445 DOLLEY MADISON RD STE 410
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-5167
Practice Address - Country:US
Practice Address - Phone:336-292-1510
Practice Address - Fax:336-292-0679
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRN188186364SP0809X
NC5001453363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6113023Medicaid
NCP00285018OtherRR MCARE W PARADIGM
NCQ 62886Medicare UPIN
NC2809931AMedicare PIN