Provider Demographics
NPI:1255829768
Name:BEAL, JESSICA (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BEAL
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:13808 PROFESSIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7948
Mailing Address - Country:US
Mailing Address - Phone:704-377-4009
Mailing Address - Fax:704-602-6563
Practice Address - Street 1:2015 RANDOLPH RD STE 208
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1200
Practice Address - Country:US
Practice Address - Phone:704-377-4009
Practice Address - Fax:704-377-7406
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2022-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-07768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant