Individual ProviderJessica KenyonNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1100 Metropolitan Ave Ste 150, Charlotte, NC 28204-3351(866) 465-0090PECOS EnrollmentBased on the most recent information from CMS, provider Jessica Kenyon does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:59 PM.Profile DetailsProvider ID1538885447Provider TypeIndividualFull NameKenyon, JessicaGenderFemaleSole ProprietorNoEnumeration Date10/13/2022Last Updated10/13/2022Contact InformationPractice LocationPractice Address1100 Metropolitan Ave Ste 150, Charlotte, NC 28204-3351Phone(866) 465-0090FaxUnlisted FaxMailing LocationMailing Address3541 Hornets Nest Way, Charlotte, NC 28208-5227PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense5017051North CarolinaProvider IdentifiersIDDescriptionIssuerID5017051DescriptionOtherIssuerNCBONNorth Carolina