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NPI Code Detail

MEDICARE: JOANN KATE JACKSON PAC

MEDICARE: JOANN KATE JACKSON PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant001002237NC

General Provider Information

NPI Number : 1265755524
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANN KATE JACKSON PAC
Provider Business Mailing Address
First Line : 1099 MEDICAL CENTER DR
Second Line : SUITE 201
City : WILMINGTON
State : NC
Zip : 28401-7346
Country : US
Telephone Number : 910-251-9944
Fax Number : 910-763-4666
Provider Business Practice Location Address
First Line : 1099 MEDICAL CENTER DR
Second Line : SUITE 201
City : WILMINGTON
State : NC
Zip : 28401-7346
Country : US
Telephone Number : 910-251-9944
Fax Number : 910-763-4666
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2010
Last Update Date : 11/08/2011

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Directions to “ JOANN KATE JACKSON PAC” Practice Location

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