Healthcare Provider Details

I. General information

NPI: 1922080951
Provider Name (Legal Business Name): JESSICA HARDIN ENYEART PA-C, MPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LYNN HARDIN

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COASTAL CAROLINA NEUROPSYCHIATRIC CENTER 200 TARPON TRAIL
JACKSONVILLE NC
28546
US

IV. Provider business mailing address

COASTAL CAROLINA NEUROPSYCHIATRIC CENTER 200 TARPON TRAIL
JACKSONVILLE NC
28546
US

V. Phone/Fax

Practice location:
  • Phone: 910-938-1114
  • Fax: 910-938-1118
Mailing address:
  • Phone: 910-938-1114
  • Fax: 910-938-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-00294
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: