Individual
JENNIFER FUQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-3208
(336) 716-3245
(336) 716-0567
Mailing address
1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-3245
(336) 716-0567
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
102054
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102054
PA LICENSE NUMBER
NC
Enumeration date
07/27/2006
Last updated
02/15/2021
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