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JACKLYN PEARSON WURTHMANN PA-C

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1679057541

Individual Registrant:
 JACKLYN PEARSON WURTHMANN PA-C
Gender: F
Not Sole Proprietor

Location and contact information for practice:
306 STATION 22 1/2 ST  SULLIVANS ISLAND, SC 29482-9756 US
Tel: 843-883-3176  Fax: --

Contact information for business:
PO BOX 751649  CHARLOTTE, NC 28275-1649 US
Tel: 843-789-1620  Fax: --

Registration Information:
NPI: 1679057541
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
SC3091

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
3876PASC05




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