Provider Demographics
NPI:1215536784
Name:JARVIS, JESSICA SMALL (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SMALL
Last Name:JARVIS
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 OLD WALKER MILL RD
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-7238
Mailing Address - Country:US
Mailing Address - Phone:336-963-2424
Mailing Address - Fax:
Practice Address - Street 1:10 DUKE MEDICINE CIR FL 8
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-1000
Practice Address - Country:US
Practice Address - Phone:919-385-8341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013698363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine