Provider Demographics
NPI:1184899411
Name:SEGURA, JENNIFER SMITH (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SMITH
Last Name:SEGURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7810 BALLANTYNE COMMONS PKWY
Mailing Address - Street 2:STE 201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3415
Mailing Address - Country:US
Mailing Address - Phone:980-213-3530
Mailing Address - Fax:980-213-3579
Practice Address - Street 1:7810 BALLANTYNE COMMONS PKWY
Practice Address - Street 2:STE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3415
Practice Address - Country:US
Practice Address - Phone:980-213-3530
Practice Address - Fax:980-213-3579
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1409362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry