Provider Demographics
NPI:1265041602
Name:GREGORY, JAMIE NICOLE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:NICOLE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 N NC 16 BUSINESS HWY STE A
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8741
Mailing Address - Country:US
Mailing Address - Phone:704-660-4041
Mailing Address - Fax:704-489-2900
Practice Address - Street 1:1217 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3511
Practice Address - Country:US
Practice Address - Phone:704-838-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2024-03-28
Deactivation Date:2021-07-23
Deactivation Code:
Reactivation Date:2021-08-17
Provider Licenses
StateLicense IDTaxonomies
NC5014842363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner