MEDICARE: JACKIE POSVAR 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	0010-07205	NC

General Provider Information

NPI Number	:	1952768194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE POSVAR PA-C

Provider Business Mailing Address
First Line	:	1800 N SANDHILLS BLVD
Second Line	:
City	:	ABERDEEN
State	:	NC
Zip	:	28315-2336
Country	:	US
Telephone Number	:	910-724-2334
Fax Number	:	910-246-0952

Provider Business Practice Location Address
First Line	:	1800 N SANDHILLS BLVD
Second Line	:
City	:	ABERDEEN
State	:	NC
Zip	:	28315-2336
Country	:	US
Telephone Number	:	910-724-2334
Fax Number	:	910-246-0952

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

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	02/01/2022

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