Provider Demographics
NPI:1053660613
Name:PINEDA, JESSICA MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIE
Last Name:PINEDA
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 744786
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4786
Mailing Address - Country:US
Mailing Address - Phone:704-834-2450
Mailing Address - Fax:704-671-5331
Practice Address - Street 1:214 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3106
Practice Address - Country:US
Practice Address - Phone:704-730-1228
Practice Address - Fax:704-730-1231
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2020-02-24
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Provider Licenses
StateLicense IDTaxonomies
NC0010-03704363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant