Provider Demographics
NPI:1760640841
Name:JENNETTE, MILLICENT CALENA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MILLICENT
Middle Name:CALENA
Last Name:JENNETTE
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Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:2035 VALLEYGATE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3984
Mailing Address - Country:US
Mailing Address - Phone:910-484-8009
Mailing Address - Fax:910-484-2205
Practice Address - Street 1:2035 VALLEYGATE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3984
Practice Address - Country:US
Practice Address - Phone:910-484-8009
Practice Address - Fax:910-484-2205
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC103905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant