Individual
JILLIAN NICOLE BADGER-REYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5970 FAIRVIEW RD STE 430, CHARLOTTE, NC 28210-3117
(979) 450-9820
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-09399
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281786803
—
TX
01
—
8883NA
BCBS
TX
Enumeration date
06/13/2011
Last updated
08/05/2024
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