Jenny Anne Addison, RN, MSN, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

222777 Issued in NC

Practice address

11635 N Main St
Suite E
Archdale, NC 27263-3270

Phone

(336) 861-4110

NPI assigned

Aug 11, 2013

Sex

Female

Sole proprietor

No

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.

• Robinhood Integrative Health, PLLC

  • Primary Care Clinic/Center
  • Winston Salem, NC
  • NPI 1760771406
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Feb 22, 2017 through Feb 22, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

• Jenny Anne Reilly Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 11, 2013.

{
    "created_epoch": "1376179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376179200000",
    "number": "1831522150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5986 HOLLOW WOOD CT",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271043771",
            "telephone_number": "336-972-3830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11635 N MAIN ST",
            "address_2": "SUITE E",
            "city": "ARCHDALE",
            "state": "NC",
            "postal_code": "272633270",
            "telephone_number": "336-861-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADDISON",
        "first_name": "JENNY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "RN, MSN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-11",
        "last_updated": "2013-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "222777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNY",
            "last_name": "REILLY",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• 625 Ashland Street Opco LLC
• Above & Beyond Community Services
• Charles R. Absher10
• Barton Adkins, PHARMD
• Affect Provider Group P.S.C.
• Affect Provider Group, P.S.C.
• Agape & Harmony Enrichment Center LLC
• Archdale Drug Co Inc

• All providers in Archdale, NC
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.