Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2016-00535 | NC |
N | 207Q00000X | Family Doctor | DR.0060018 | CO |
N | 207Q00000X | Family Doctor | LL34760 | SC |
NPI | 1003179532 |
---|---|
Provider Name | Jessica Hart St. John |
First Address | Winston Salem, NC 27109-6000 |
Second Address | Winston Salem, NC 27109-6000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2012 |
Last Update Date | 11/05/2021 |