Provider Demographics
NPI:1841625126
Name:WAGONER, JESSICA B (PA-C)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:B
Last Name:WAGONER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:244 MEDSPRING DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-9293
Mailing Address - Country:US
Mailing Address - Phone:919-359-0291
Mailing Address - Fax:919-553-2907
Practice Address - Street 1:244 MEDSPRING DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-9293
Practice Address - Country:US
Practice Address - Phone:919-359-0291
Practice Address - Fax:919-553-2907
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2021-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-04444363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant