Individual provider Active NPI

Jessica Putnam, AGACNP

  • Acute Care Nurse Practitioner
  • Gastonia, NC
National Provider Identifier
1073334819
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
5021086 Issued in NC
Practice address
2555 Court Dr Ste 200
Gastonia, NC 28054-2178
Phone
(704) 834-3278
Fax
(704) 868-5870
NPI assigned
Oct 23, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 224690 NC
Acute Care Nurse Practitioner 363LA2100X 5021086 NC Primary

Addresses

Primary practice location

2555 Court Dr Ste 200
Gastonia, NC 28054-2178

Mailing address

PO Box 744786
Atlanta, GA 30374-4786

Other practice location 1

2525 Court Dr
Gastonia, NC 28054-2140
Phone (704) 834-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250221000504 NC Practitioner - Nurse Practitioner 9931629987 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Caromont Medical Group IncGroup PAC ID 3577476258, 425 clinicians

Practice addresses (Care Compare)

2555 Court Dr
Suite 200
Gastonia, NC 28054-2178
Phone (704) 867-2141

660 Summit Crossing PL
Suite 301
Gastonia, NC 28054-2181
Phone (704) 854-8799

Hospital & facility affiliations

  • Caromont Regional Medical Center Hospital, Gastonia, NC, CCN 340032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
224690NCMDAcute Care Nurse Practitioner
5021086NCMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Caromont Medical Group Inc Current Accepting new patients
Caromont Medical Group Inc CurrentSince Jan 15, 2025 Accepting new patients
Caromont Medical Group Inc CurrentSince Jan 15, 2025 Accepting new patients

Locations

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

2555 Court Dr
Ste 200
Gastonia, NC 28054
Phone (704) 671-7670

660 Summit Crossing Pl
Ste 301
Gastonia, NC 28054
Phone (704) 854-8799

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1073334819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 744786",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303744786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 COURT DR STE 200",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542178",
            "telephone_number": "704-834-3278",
            "fax_number": "704-868-5870"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2525 Court Dr",
            "address_purpose": "LOCATION",
            "city": "Gastonia",
            "state": "NC",
            "postal_code": "280542140",
            "country_code": "US",
            "telephone_number": "704-834-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUTNAM",
        "first_name": "JESSICA",
        "credential": "AGACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-23",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NC",
            "license": "224690",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NC",
            "license": "5021086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

Verify at the official NPI Registry.