Provider Demographics
NPI:1760616247
Name:ANGE, JESSICA ROYD (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROYD
Last Name:ANGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 HEALTH SERVICES RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-3000
Mailing Address - Country:US
Mailing Address - Phone:336-372-5641
Mailing Address - Fax:
Practice Address - Street 1:157 HEALTH SERVICES RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-3000
Practice Address - Country:US
Practice Address - Phone:336-372-5641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00325207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program