Individual
JENNY BROOKE BAUCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-04752
NC
Other
Enumeration date
01/15/2014
Last updated
04/07/2023
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