Provider Demographics
NPI:1467088260
Name:DYER, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DYER
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 1:3439 N MARLEY FORD RD
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:NC
Mailing Address - Zip Code:28624-8903
Mailing Address - Country:US
Mailing Address - Phone:336-927-5940
Mailing Address - Fax:
Practice Address - Street 1:755 S STATE ST
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-7756
Practice Address - Country:US
Practice Address - Phone:336-849-4171
Practice Address - Fax:336-849-4170
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCDYER-WA4AFH363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner