Basic Information
| Provider Information | |||||||||
| NPI: | 1760090591 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICH | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 DOCTORS CIR STE 2&3 | ||||||||
| Address2: | |||||||||
| City: | SUPPLY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284621101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107546141 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 18 DOCTORS CIRCLE SW | ||||||||
| Address2: | |||||||||
| City: | SUPPLY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284621101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107546141 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2020 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 153681 | NC | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 5013325 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.