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NPI Code Detail

MEDICARE: MRS. JESSICA RHEA RODRIGUEZ PA

MEDICARE: MRS. JESSICA RHEA RODRIGUEZ 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 Assistant001003295NC

General Provider Information

NPI Number : 1346512951
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA RHEA RODRIGUEZ PA
Provider Business Mailing Address
First Line : PO BOX 2723
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27802-2723
Country : US
Telephone Number : 252-212-3487
Fax Number : 252-212-3497
Provider Business Practice Location Address
First Line : 111 S FAIRVIEW RD
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27801-6971
Country : US
Telephone Number : 252-446-3333
Fax Number : 252-446-0426
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2012
Last Update Date : 05/13/2014

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