Provider Demographics
NPI:1568484749
Name:PURVIS, JENNIFER H (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:H
Last Name:PURVIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3521
Mailing Address - Country:US
Mailing Address - Phone:252-443-7114
Mailing Address - Fax:252-443-7115
Practice Address - Street 1:3301 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3521
Practice Address - Country:US
Practice Address - Phone:252-443-7114
Practice Address - Fax:252-443-7115
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC622213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCJ639AMedicare UPIN