Provider Demographics
NPI:1003018136
Name:JACKSON, ANGELA CHASE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CHASE
Last Name:JACKSON
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:413 OWEN DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3411
Mailing Address - Country:US
Mailing Address - Phone:910-323-9111
Mailing Address - Fax:910-484-2535
Practice Address - Street 1:413 OWEN DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3411
Practice Address - Country:US
Practice Address - Phone:910-323-9111
Practice Address - Fax:910-484-2535
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant