Provider Demographics
NPI:1518078195
Name:LASSITER, JENNIFER WHORLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:WHORLEY
Last Name:LASSITER
Suffix:
Gender:F
Credentials:MD
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:844-266-8267
Mailing Address - Fax:
Practice Address - Street 1:6488 WEDDINGTON-MONROE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28104-6277
Practice Address - Country:US
Practice Address - Phone:704-384-8460
Practice Address - Fax:704-384-1018
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200601450208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905254Medicaid
NC5905254Medicaid