Provider Demographics
NPI:1922080951
Name:ENYEART, JESSICA HARDIN (PA-C, MPAS)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:HARDIN
Last Name:ENYEART
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:COASTAL CAROLINA NEUROPSYCHIATRIC CENTER
Mailing Address - Street 2:200 TARPON TRAIL
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546
Mailing Address - Country:US
Mailing Address - Phone:910-938-1114
Mailing Address - Fax:910-938-1118
Practice Address - Street 1:COASTAL CAROLINA NEUROPSYCHIATRIC CENTER
Practice Address - Street 2:200 TARPON TRAIL
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:910-938-1114
Practice Address - Fax:910-938-1118
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00294363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant