Provider Demographics
NPI:1952768194
Name:POSVAR, JACKIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:POSVAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1800 N SANDHILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2336
Mailing Address - Country:US
Mailing Address - Phone:910-724-2334
Mailing Address - Fax:910-246-0952
Practice Address - Street 1:1800 N SANDHILLS BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2336
Practice Address - Country:US
Practice Address - Phone:910-724-2334
Practice Address - Fax:910-246-0952
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-07205363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant