Provider Demographics
NPI:1346549854
Name:DEESE, JENNIFER P (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:P
Last Name:DEESE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-8460
Mailing Address - Fax:
Practice Address - Street 1:1994 WELLNESS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-7768
Practice Address - Country:US
Practice Address - Phone:704-384-8460
Practice Address - Fax:704-384-8465
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006260363L00000X
NC157484363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner