Individual
JESSICA LYNNE BLALOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-6670
(336) 716-2700
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2700
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5015539
NC
363LA2200X
Adult Health Nurse Practitioner
5015539
NC
Other
Enumeration date
10/27/2021
Last updated
10/09/2023
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