Provider Demographics
NPI:1912300179
Name:GESMOND, JESSIE R (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:R
Last Name:GESMOND
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:R
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:8901 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9116
Practice Address - Country:US
Practice Address - Phone:843-203-2245
Practice Address - Fax:843-203-2244
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2974Medicaid
SCSC46627498Medicare PIN
SCSC46626882Medicare PIN
SCSC46627126Medicare PIN
SCSC46627819Medicare PIN
SCSC46625282Medicare PIN
SCNP2974Medicaid
SCSC46627499Medicare PIN
SCSC46627555Medicare PIN
SCSC46625281Medicare PIN
SCSC46627006Medicare PIN
SCSC46626834Medicare PIN
SCSC46628798Medicare PIN
SCSC46625277Medicare PIN