Provider Demographics
NPI:1205086006
Name:CARROLL, JENNIFER KELLY WILLIAMS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KELLY WILLIAMS
Last Name:CARROLL
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:612 MOCKSVILLE AVE
Mailing Address - Street 2:ROWAN REGIONAL MEDICAL CENTER- NOVANT HEATH
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-8402
Mailing Address - Country:US
Mailing Address - Phone:704-644-9290
Mailing Address - Fax:
Practice Address - Street 1:612 MOCKSVILLE AVE
Practice Address - Street 2:ROWAN REGIONAL MEDICAL CENTER- NOVANT HEALTH
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-8402
Practice Address - Country:US
Practice Address - Phone:704-644-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2014-10-10
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Provider Licenses
StateLicense IDTaxonomies
NC0010-01533363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant