MEDICARE: JAYLA MARIE CAFFEY

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	001014649	NC

General Provider Information

NPI Number	:	1891496824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYLA MARIE CAFFEY

Provider Business Mailing Address
First Line	:	2401 TUCKASEEGEE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-4058
Country	:	US
Telephone Number	:	256-541-8582
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 TUCKASEEGEE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-4058
Country	:	US
Telephone Number	:	704-409-3000
Fax Number	:

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

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	10/08/2024

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