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General NPI Number Information
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NPI Number | 1215966700
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Entity Type | Individual
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Provider Name | JENNIFER HENDRIX SHUPING PAC
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Gender | Female
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 627 N MAIN ST
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City | WAYNESVILLE
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State | NC
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Zip | 28786-3819
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Country | US
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Telephone | 828-456-2784
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Fax | 828-456-8903
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Provider Business Mailing Address
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Address Line | 94 ROYAL CREST HTS
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City | WAYNESVILLE
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State | NC
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Zip | 28786-2044
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Country | US
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Telephone | 828-456-4231
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Fax | 828-454-5288
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 101981
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License Number State | NC
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