Provider Demographics
NPI:1639977358
Name:CARTER, JESSICA A (CNA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:CARTER
Suffix:
Gender:
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 WILLOW CREEK RUN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27537-4395
Mailing Address - Country:US
Mailing Address - Phone:252-820-0825
Mailing Address - Fax:
Practice Address - Street 1:262 WILLOW CREEK RUN
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27537-4395
Practice Address - Country:US
Practice Address - Phone:252-820-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
313M00000X
NC581167251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility