MEDICARE: JESSICA SHOWMAN CARTER 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	0110005167	VA
2	363A00000X	Physician Assistant	PA9105889	FL

General Provider Information

NPI Number	:	1952606444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SHOWMAN CARTER PA-C

Provider Business Mailing Address
First Line	:	860 OMNI BLVD STE 101
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4430
Country	:	US
Telephone Number	:	757-232-8769
Fax Number	:	757-232-8875

Provider Business Practice Location Address
First Line	:	1300 SENTARA PARK
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5884
Country	:	US
Telephone Number	:	757-252-1500
Fax Number	:

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

Provider Enumeration Date	:	01/14/2011
Last Update Date	:	04/24/2024

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