Basic Information
| Provider Information | |||||||||
| NPI: | 1780335687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEWITT | ||||||||
| FirstName: | JADA | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 N THUNDERBIRD CIR STE 303 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852151219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807761636 | ||||||||
| FaxNumber: | 4807760025 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 CABARRUS AVE E | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280253699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8557432247 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2022 | ||||||||
| LastUpdateDate: | 10/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5015611 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 5015611 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.