Provider Demographics
NPI:1073542502
Name:PRESTON, JENNIFER HITCH
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HITCH
Last Name:PRESTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LAWRENCE
Other - Last Name:LAUGHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5115 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7018
Mailing Address - Country:US
Mailing Address - Phone:910-362-1011
Mailing Address - Fax:
Practice Address - Street 1:5115 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7018
Practice Address - Country:US
Practice Address - Phone:910-362-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103631363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2756756BMedicare PIN
NCP70925Medicare UPIN