Active NPI
Jennifer E McConnell, ED.S., LPA
- Psychologist
- Charlotte, NC
National Provider Identifier
1356584783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2618
- Practice address
- 8840 Blakeney Professional Dr
Suite 200
Charlotte, NC 28277-6718 - Phone
- (704) 552-0116
- Fax
- (704) 552-7550
- NPI assigned
- Apr 15, 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2618 | NC | Primary |
Addresses
Primary practice location
8840 Blakeney Professional Dr
Suite 200
Charlotte, NC 28277-6718
Mailing address
6115 Park South Dr
Suite 130
Charlotte, NC 28210-3269
Phone (704) 552-0116
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2618 | NC | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1250121600000",
"number": "1356584783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6115 PARK SOUTH DR",
"address_2": "SUITE 130",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282103269",
"telephone_number": "704-552-0116",
"fax_number": "704-552-7550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8840 BLAKENEY PROFESSIONAL DR",
"address_2": "SUITE 200",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282776718",
"telephone_number": "704-552-0116",
"fax_number": "704-552-7550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCONNELL",
"first_name": "JENNIFER",
"middle_name": "E",
"credential": "ED.S., LPA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-15",
"last_updated": "2009-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "2618",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.