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NPI Code Detail

MEDICARE: JENNIFER MARIE SHORT P.A.-C

MEDICARE: JENNIFER MARIE SHORT P.A.-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
1363AM0700XMedical Physician Assistant0010-02003NC
2363A00000XPhysician Assistant001002003NC

General Provider Information

NPI Number : 1750617874
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MARIE SHORT P.A.-C
Provider Business Mailing Address
First Line : 13845 CONLAN CIRCLE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-0060
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13845 CONLAN CIR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-2705
Country : US
Telephone Number : 704-544-2092
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2009
Last Update Date : 10/02/2017

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