Provider Demographics
NPI:1841329885
Name:PEPPER, JEREMY SETH (PA-C)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:SETH
Last Name:PEPPER
Suffix:
Gender:M
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 1:1606 WELLINGTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7704
Mailing Address - Country:US
Mailing Address - Phone:910-859-8586
Mailing Address - Fax:910-859-8588
Practice Address - Street 1:1606 WELLINGTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7747
Practice Address - Country:US
Practice Address - Phone:910-859-8586
Practice Address - Fax:910-859-8588
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103010363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB119Medicare PIN