Provider Demographics
NPI:1013122746
Name:GATES, JEANNE PATRICIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:PATRICIA
Last Name:GATES
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 1:1600 HIGHWAY 17 N
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-6015
Mailing Address - Country:US
Mailing Address - Phone:843-238-4520
Mailing Address - Fax:843-361-4045
Practice Address - Street 1:1714 HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-4041
Practice Address - Country:US
Practice Address - Phone:843-361-0705
Practice Address - Fax:843-361-4045
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL1299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL1299OtherPA