Provider Demographics
NPI:1851593792
Name:LAYTON, JENNIFER A (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:LAYTON
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 1:1225 LEWISVILLE CLEMMONS RD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-3168
Mailing Address - Country:US
Mailing Address - Phone:336-712-0700
Mailing Address - Fax:
Practice Address - Street 1:390 W SALEM AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5861
Practice Address - Country:US
Practice Address - Phone:336-721-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant