Individual
JESSA NICOLE MCGRATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
6035 FAIRVIEW RD, CHARLOTTE, NC 28210-3256
(704) 295-3000
Mailing address
6035 FAIRVIEW RD, CHARLOTTE, NC 28210-3256
(704) 295-3000
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
12075
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1259922
WELLCARE
SC
01
—
19PMS
BCBS NC
NC
01
—
P01875989
RAILROAD MEDICARE
NC
01
—
Q54160A
MEDICARE
NC
05
—
SAN134
—
SC
Enumeration date
07/12/2016
Last updated
04/27/2021
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