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JACKLYN PEARSON WURTHMANN PA-C
>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1679057541
Individual Registrant: JACKLYN PEARSON WURTHMANN PA-C
Gender: F
Not Sole Proprietor
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: --
Tel: 843-883-3176 Fax: --
Contact information for business:
PO BOX 751649 CHARLOTTE, NC 28275-1649 US
Tel: 843-789-1620 Fax: --
Tel: 843-789-1620 Fax: --
Registration Information:
NPI: 1679057541
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | SC | 3091 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 3876PA | SC | 05 |
