Provider Demographics
NPI:1164649521
Name:ARMSTRONG, JEREMY CRAIG (PA-C)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:CRAIG
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 ELEANOR ROOSEVELT LN
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:NC
Mailing Address - Zip Code:28478-6621
Mailing Address - Country:US
Mailing Address - Phone:910-285-0400
Mailing Address - Fax:303-269-4411
Practice Address - Street 1:5531 ELEANOR ROOSEVELT LN
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:NC
Practice Address - Zip Code:28478-6621
Practice Address - Country:US
Practice Address - Phone:910-285-0400
Practice Address - Fax:303-269-4411
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03312363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70480885Medicaid
COCO304035Medicare PIN