Provider Demographics
NPI:1851947691
Name:HALAMA, JENNIFER KAITLYN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAITLYN
Last Name:HALAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 ENOS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-6655
Mailing Address - Country:US
Mailing Address - Phone:302-632-6716
Mailing Address - Fax:
Practice Address - Street 1:315 W COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28017
Practice Address - Country:US
Practice Address - Phone:704-406-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical