Healthcare Provider Details

I. General information

NPI: 1649649559
Provider Name (Legal Business Name): JACOB JARRETT MMS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 N MITCHELL AVE
BAKERSVILLE NC
28705-6502
US

IV. Provider business mailing address

PO BOX 27
BAKERSVILLE NC
28705-0027
US

V. Phone/Fax

Practice location:
  • Phone: 828-688-2104
  • Fax:
Mailing address:
  • Phone: 828-675-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-06014
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: