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Individual

JESSE ENTERLINE BACCUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
100 MEDICAL DR, ELIZABETH CITY, NC 27909-3361
(252) 384-2600
Mailing address
600 MOYE BLVD, GREENVILLE, NC 27834-4300

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5020391
NC
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
08/24/2022
Last updated
08/12/2024
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