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1437154093

NPI Code Detail

MEDICARE: MRS. JENNIFER MARIE HULL PA-C

MEDICARE: MRS. JENNIFER MARIE HULL PA-C

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
1	363A00000X	Physician Assistant	MA051750	PA
2	363A00000X	Physician Assistant	0010-06357	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	NCS417A	OTHER	NC	MEDICARE
4	P00170527	OTHER	PA	RR MEDICARE
5	P01848168	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19HS5	OTHER	NC	BCBS
3	1669926	OTHER	PA	BLUE SHIELD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437154093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MARIE HULL PA-C

Provider Business Mailing Address
First Line	:	149 PLANTATION RIDGE DR
Second Line	:	SUITE 190
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-9174
Country	:	US
Telephone Number	:	704-658-0595
Fax Number	:	704-658-0916

Provider Business Practice Location Address
First Line	:	6035 FAIRVIEW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3256
Country	:	US
Telephone Number	:	704-295-3000
Fax Number	:	704-295-3468

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/17/2017

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Directions to “ MRS. JENNIFER MARIE HULL PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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