Provider Demographics
NPI:1689996449
Name:O'CONNELL, JOHN JENNINGS (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JENNINGS
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 16367
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28816-0367
Mailing Address - Country:US
Mailing Address - Phone:828-252-8957
Mailing Address - Fax:828-255-8028
Practice Address - Street 1:1201 PATTON AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2702
Practice Address - Country:US
Practice Address - Phone:828-252-4878
Practice Address - Fax:828-252-4103
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 363A00000X
NC0010-02195363A00000X
NC001002195363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner