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Organization
JESSUP FOOT AND ANKLE SPECIALISTS, PA
Active
Organization
JESSUP FOOT AND ANKLE SPECIALISTS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REVONDA JESSUP DPM (PHYSICIAN/CO-OWNER)
(336) 414-1268
Entity
Organization
Contact information
Practice address
9601 HOLLY POINT DR, SUITE 203, HUNTERSVILLE, NC 28078-4910
(336) 414-1268
Mailing address
9601 HOLLY POINT DR, SUITE 203, HUNTERSVILLE, NC 28078-4910
(336) 414-1268
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
NULL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5916541
—
NC
Enumeration date
11/17/2010
Last updated
06/06/2011
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