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General NPI Number Information
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NPI Number | 1205386109
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Entity Type | Individual
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Provider Name | JENNIFER CAMPBELL GRANT PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 2206 PATTERSON AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-2524
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Country | US
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Telephone | 540-906-2739
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Fax |
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Provider Business Mailing Address
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Address Line | 4080 GRANITE CIR
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City | INDIAN LAND
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State | SC
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Zip | 29707-4000
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Country | US
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Telephone | 561-729-7015
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-06799
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-06799
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License Number State | NC
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