Jeanne Patricia Gates, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

TL1299 Issued in SC

Practice address

1714 Highway 17 S
North Myrtle Beach, SC 29582-4041

Phone

(843) 361-0705

Fax

(843) 361-4045

NPI assigned

May 14, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205366400000",
    "number": "1013122746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 HIGHWAY 17 N",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "295756015",
            "telephone_number": "843-238-4520",
            "fax_number": "843-361-4045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1714 HIGHWAY 17 S",
            "city": "NORTH MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295824041",
            "telephone_number": "843-361-0705",
            "fax_number": "843-361-4045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATES",
        "first_name": "JEANNE",
        "middle_name": "PATRICIA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-14",
        "last_updated": "2008-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "TL1299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA",
            "identifier": "TL1299",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in North Myrtle Beach, SC
• Providers in North Myrtle Beach, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.