Individual
MRS. JESSICA ROSE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4525 CAMERON VALLEY PKWY, SUITE 4100, CHARLOTTE, NC 28211-4369
(704) 302-9300
(704) 302-9301
Mailing address
PO BOX 601643, CHARLOTTE, NC 28260-1643
(704) 302-9300
(704) 302-9301
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001004358
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427499862
—
NC
05
—
1690PA
—
SC
Enumeration date
07/15/2013
Last updated
06/04/2014
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