Active NPI
Jessica E Provost, M.S. CCC-SLP
- Speech-Language Pathologist
- Apex, NC
National Provider Identifier
1326242652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 7545
- Practice address
- 6033 Larboard Dr.
Apex, NC 27539-4115 - Phone
- (919) 329-7733
- NPI assigned
- Jun 12, 2007
- Last updated
- Aug 6, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 7545 | NC | Primary |
Addresses
Primary practice location
6033 Larboard Dr.
Apex, NC 27539-4115
Mailing address
6033 Larboard Dr.
Apex, NC 27539-4115
Phone (919) 329-7733
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7412731 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7545 | NC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249516800000",
"number": "1326242652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6033 LARBOARD DR.",
"city": "APEX",
"state": "NC",
"postal_code": "275394115",
"telephone_number": "919-329-7733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6033 LARBOARD DR.",
"city": "APEX",
"state": "NC",
"postal_code": "275394115",
"telephone_number": "919-329-7733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVOST",
"first_name": "JESSICA",
"middle_name": "E",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-12",
"last_updated": "2009-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NC",
"license": "7545",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7412731",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Apex, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.