Healthcare Provider Details

I. General information

NPI: 1063605137
Provider Name (Legal Business Name): JASON D. MCNEESE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165-G CEDAR POINT BLVD
CEDAR POINT NC
28584-8023
US

IV. Provider business mailing address

1165-G CEDAR POINT BLVD
CEDAR POINT NC
28584-8023
US

V. Phone/Fax

Practice location:
  • Phone: 252-393-3340
  • Fax: 252-222-3245
Mailing address:
  • Phone: 252-393-3340
  • Fax: 252-222-3245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.002294
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-05159
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: