Provider Demographics
NPI:1992035794
Name:WOODSTOCK, JENNIFER ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:WOODSTOCK
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5319 BEACON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-8692
Mailing Address - Country:US
Mailing Address - Phone:828-322-3898
Mailing Address - Fax:828-322-5485
Practice Address - Street 1:1321 N CENTER ST
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2535
Practice Address - Country:US
Practice Address - Phone:828-322-3898
Practice Address - Fax:828-322-5485
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC001002157363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-02157OtherMEDICAL LICENSE