Individual
JACKLYN PEARSON WURTHMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
306 STATION 22 1/2 ST, SULLIVANS ISLAND, SC 29482-9756
(843) 883-3176
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3091
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3876PA
—
SC
Enumeration date
09/18/2018
Last updated
10/25/2021
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