Provider Demographics
NPI:1780079608
Name:BATESON, JEANNA J (PA)
Entity type:Individual
Prefix:MRS
First Name:JEANNA
Middle Name:J
Last Name:BATESON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JEANNA
Other - Middle Name:J
Other - Last Name:GARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BOX 3886 DUMC
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-684-6721
Mailing Address - Fax:919-681-7085
Practice Address - Street 1:2100 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705
Practice Address - Country:US
Practice Address - Phone:919-684-6721
Practice Address - Fax:919-681-7085
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004975363A00000X
NC0010-07904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1780079608Medicaid
VAP01546221OtherRAILROAD
VAVVI167AMedicare PIN