Provider Demographics
NPI:1497738744
Name:MCCARSON, JERI ALLISON (DNP, CNM)
Entity Type:Individual
Prefix:MRS
First Name:JERI
Middle Name:ALLISON
Last Name:MCCARSON
Suffix:
Gender:F
Credentials:DNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DOCTORS DR STE F
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6308
Mailing Address - Country:US
Mailing Address - Phone:910-353-1499
Mailing Address - Fax:910-355-0404
Practice Address - Street 1:200 DOCTORS DR STE F
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6308
Practice Address - Country:US
Practice Address - Phone:910-353-1499
Practice Address - Fax:910-355-0404
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0992699173000000X, 174400000X, 173000000X
NC816367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
No174400000XOther Service ProvidersSpecialist
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1508027046Medicaid