Individual provider Active NPI

Jesica Demumbreum, DNP, PMHNP-BC, IBCLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1679985683
Registry record updated Aug 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
5017873 Issued in NC
Practice address
1977 J N Pease PL Ste 202
Charlotte, NC 28262-4527
Phone
(704) 817-8230
Fax
(704) 665-5645
NPI assigned
May 24, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 12, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 5017873 NC Primary

Addresses

Primary practice location

1977 J N Pease PL Ste 202
Charlotte, NC 28262-4527

Mailing address

1977 J.N. Please Place
Suite 202
Charlotte, NC 28262
Phone (704) 817-8230

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 - Nursing

State licenses

LicenseStateTypeSpecialty
5017873NCMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1400889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786492800000",
    "number": "1679985683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1977 J.N. PLEASE PLACE",
            "address_2": "SUITE 202",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28262",
            "telephone_number": "704-817-8230",
            "fax_number": "704-665-5645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1977 J N PEASE PL STE 202",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624527",
            "telephone_number": "704-817-8230",
            "fax_number": "704-665-5645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMUMBREUM",
        "first_name": "JESICA",
        "credential": "DNP, PMHNP-BC, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-24",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5017873",
            "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 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.