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General NPI Number Information
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NPI Number | 1427499862
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Entity Type | Individual
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Provider Name | JESSICA ROSE ANDERSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 4525 CAMERON VALLEY PKWY SUITE 4100
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City | CHARLOTTE
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State | NC
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Zip | 28211-4369
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Country | US
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Telephone | 704-302-9300
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Fax | 704-302-9301
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Provider Business Mailing Address
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Address Line | PO BOX 601643
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City | CHARLOTTE
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State | NC
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Zip | 28260-1643
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Country | US
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Telephone | 704-302-9300
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Fax | 704-302-9301
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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 | 001004358
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License Number State | NC
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