Healthcare Provider Details

I. General information

NPI: 1205974219
Provider Name (Legal Business Name): JANE SHARPE JOHNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7513 HIGHWAY 24 AND CLINTON RD
STEDMAN NC
28391
US

IV. Provider business mailing address

5623 WESTBRANCH DR
FAYETTEVILLE NC
28306-8054
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-7776
  • Fax: 910-483-1373
Mailing address:
  • Phone: 910-426-4745
  • Fax: 910-483-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number103685
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: