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NPI Code Detail

MEDICARE: JESSICAH JULINDA RAY PA

MEDICARE: JESSICAH JULINDA RAY PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant001001742NC
2363A00000XPhysician AssistantC0006768MD

General Provider Information

NPI Number : 1114152790
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICAH JULINDA RAY PA
Provider Business Mailing Address
First Line : 100 BREWSTER BLVD
Second Line :
City : CAMP LEJEUNE
State : NC
Zip : 28547-2538
Country : US
Telephone Number : 910-450-4159
Fax Number : 910-450-4194
Provider Business Practice Location Address
First Line : 20 UNIVERSITY BLVD E
Second Line :
City : SILVER SPRING
State : MD
Zip : 20901-2436
Country : US
Telephone Number : 888-808-6483
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2009
Last Update Date : 04/02/2019

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