Provider Demographics
NPI:1235178302
Name:CAIN, JESSICA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:CAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C, AQH, MPAS
Mailing Address - Street 1:1700 TARBORO ST W STE 102
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3481
Mailing Address - Country:US
Mailing Address - Phone:252-399-5306
Mailing Address - Fax:252-399-5307
Practice Address - Street 1:1700 TARBORO ST W STE 102
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3481
Practice Address - Country:US
Practice Address - Phone:252-399-5306
Practice Address - Fax:252-399-5307
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104050363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ36139Medicare UPIN