Provider Demographics
NPI:1497242630
Name:CONGRESS, JAICIE N (FNP-C)
Entity Type:Individual
Prefix:
First Name:JAICIE
Middle Name:N
Last Name:CONGRESS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8727 JW CLAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-5417
Mailing Address - Country:US
Mailing Address - Phone:980-999-1831
Mailing Address - Fax:877-536-8312
Practice Address - Street 1:8727 JW CLAY BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-5417
Practice Address - Country:US
Practice Address - Phone:980-999-1831
Practice Address - Fax:877-536-8312
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNN2081H224OtherMEDICARE