Provider Demographics
NPI:1407453921
Name:SCHAVONE, JACLYN RHEA (PA-C)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:RHEA
Last Name:SCHAVONE
Suffix:
Gender:F
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 1:5904 SIX FORKS RD STE 211
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8228
Mailing Address - Country:US
Mailing Address - Phone:984-242-0510
Mailing Address - Fax:984-242-0520
Practice Address - Street 1:5904 SIX FORKS RD STE 211
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8228
Practice Address - Country:US
Practice Address - Phone:984-242-0510
Practice Address - Fax:984-242-0520
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12162363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant