Provider Demographics
NPI:1982007928
Name:DEMOTTS, JESSICA STORM (NP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:STORM
Last Name:DEMOTTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 NE MAYNARD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-9670
Mailing Address - Country:US
Mailing Address - Phone:919-466-7541
Mailing Address - Fax:
Practice Address - Street 1:160 NE MAYNARD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-9670
Practice Address - Country:US
Practice Address - Phone:919-466-7541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF0914165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily