Provider Demographics
NPI:1679993836
Name:WHEELER, JACQUELINE NICOLE (PA-C, SA-C, MSOTR/L)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:NICOLE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PA-C, SA-C, MSOTR/L
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:NICOLE
Other - Last Name:DUKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, SA-C, MSOTR/L
Mailing Address - Street 1:503 E PARKER RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5104
Mailing Address - Country:US
Mailing Address - Phone:828-437-6500
Mailing Address - Fax:
Practice Address - Street 1:503 E PARKER RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5104
Practice Address - Country:US
Practice Address - Phone:828-437-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN276107225X00000X
NC0010-07236363A00000X
14-259246ZC0007X
86886246ZS0410X, 246ZS0410X
MSPA00327363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical