Provider Demographics
NPI:1376793935
Name:ENOCH, JENNA LEE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:LEE
Last Name:ENOCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5791
Mailing Address - Fax:252-536-5444
Practice Address - Street 1:110 DIVISION ST
Practice Address - Street 2:
Practice Address - City:NORLINA
Practice Address - State:NC
Practice Address - Zip Code:27563-9041
Practice Address - Country:US
Practice Address - Phone:252-456-2009
Practice Address - Fax:252-456-2889
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01522363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical