Individual
MRS. JENNIFER MARIE HULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6035 FAIRVIEW RD, CHARLOTTE, NC 28210-3256
(704) 295-3000
(704) 295-3468
Mailing address
149 PLANTATION RIDGE DR, SUITE 190, MOORESVILLE, NC 28117-9174
(704) 658-0595
(704) 658-0916
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-06357
NC
363A00000X
Physician Assistant
MA051750
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669926
BLUE SHIELD
PA
01
—
19HS5
BCBS
NC
05
—
2601PA
—
SC
01
—
NCS417A
MEDICARE
NC
01
—
P00170527
RR MEDICARE
PA
01
—
P01848168
RAILROAD MEDICARE
NC
Enumeration date
06/20/2005
Last updated
07/17/2017
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