Provider Demographics
NPI:1295775849
Name:HEDRICK, JESSICA ANN (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:HEDRICK
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 1:10880 DURANT RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6628
Mailing Address - Country:US
Mailing Address - Phone:919-719-2260
Mailing Address - Fax:919-710-2259
Practice Address - Street 1:10880 DURANT RD
Practice Address - Street 2:SUITE 110
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6628
Practice Address - Country:US
Practice Address - Phone:919-719-2260
Practice Address - Fax:919-710-2259
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00357363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical