Provider Demographics
NPI:1063605137
Name:MCNEESE, JASON D (PA-C)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:D
Last Name:MCNEESE
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 1:1165-G CEDAR POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8023
Mailing Address - Country:US
Mailing Address - Phone:252-393-3340
Mailing Address - Fax:252-222-3245
Practice Address - Street 1:1165-G CEDAR POINT BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-8023
Practice Address - Country:US
Practice Address - Phone:252-393-3340
Practice Address - Fax:252-222-3245
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002294363A00000X
NC0010-05159363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMCPA29731OtherMEDICARE PTAN