Individual
MRS. VIRGINIA ANN JETHRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1540 SUNDAY DR, RALEIGH, NC 27607-6010
(919) 782-3456
(919) 783-1441
Mailing address
1540 SUNDAY DR, RALEIGH, NC 27607-6010
(919) 782-3456
(919) 783-1441
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
103811
NC
363AM0700X
Medical Physician Assistant
Primary
103811
NC
363AM0700X
Medical Physician Assistant
MA-052635
PA
Other
Enumeration date
03/29/2006
Last updated
07/08/2026
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