Provider Demographics
NPI:1306857370
Name:BEESON, JENNIFER ANNE (PAC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANNE
Last Name:BEESON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 W CHATHAM ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-3245
Mailing Address - Country:US
Mailing Address - Phone:919-297-8682
Mailing Address - Fax:
Practice Address - Street 1:323 W CHATHAM ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3245
Practice Address - Country:US
Practice Address - Phone:919-297-8682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2759753Medicare ID - Type Unspecified
P99703Medicare UPIN