Healthcare Provider Details

I. General information

NPI: 1699425702
Provider Name (Legal Business Name): JESSICA BATTAGLIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7118 MAIN ST
WADE NC
28395-9749
US

IV. Provider business mailing address

5407 WOODARD CT
FAYETTEVILLE NC
28311-1251
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-6694
  • Fax:
Mailing address:
  • Phone: 716-374-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-11966
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: