Healthcare Provider Details

I. General information

NPI: 1740520121
Provider Name (Legal Business Name): JESSICA M SEKELSKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 HAYWOOD PARK DR
CLYDE NC
28721-4405
US

IV. Provider business mailing address

107 HAYWOOD PARK DR
CLYDE NC
28721-4405
US

V. Phone/Fax

Practice location:
  • Phone: 828-237-8001
  • Fax: 828-237-8002
Mailing address:
  • Phone: 828-237-8001
  • Fax: 828-237-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-03911
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: