Provider Demographics
NPI:1215966700
Name:SHUPING, JENNIFER HENDRIX (PAC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HENDRIX
Last Name:SHUPING
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 ROYAL CREST HTS
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-2044
Mailing Address - Country:US
Mailing Address - Phone:828-456-4231
Mailing Address - Fax:828-454-5288
Practice Address - Street 1:627 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3819
Practice Address - Country:US
Practice Address - Phone:828-456-2784
Practice Address - Fax:828-456-8903
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101981363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC2593OtherMEDCOST
NC0102081OtherUNITED HEALTH CARE
NCC2593OtherMEDCOST
NC2752154BMedicare ID - Type Unspecified