Provider Demographics
NPI:1497828511
Name:PIXTON, JAN MAREE (PAC)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:MAREE
Last Name:PIXTON
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-0129
Mailing Address - Country:US
Mailing Address - Phone:910-859-3586
Mailing Address - Fax:866-251-5115
Practice Address - Street 1:1925A OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2334
Practice Address - Country:US
Practice Address - Phone:109-251-7715
Practice Address - Fax:109-763-7845
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102080363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS80960Medicare UPIN
NC2748029CMedicare ID - Type UnspecifiedMEDICARE OF NC