Jacqueline Wardrett

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

JACQUELINE WARDRETT

Practice address

105 Saratoga LN
Clayton, NC 27520-5538

Phone

(984) 989-7361

NPI assigned

Dec 16, 2021

Organization subpart

No

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

Authorized official

Name

Jacquelin Bunch

Title

Owner

Phone

(984) 989-7361

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1639612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639612800000",
    "number": "1144989252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 SARATOGA LN",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275205538",
            "telephone_number": "984-989-7361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 SARATOGA LN",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275205538",
            "telephone_number": "984-989-7361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACQUELINE WARDRETT",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-16",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A",
        "authorized_official_last_name": "BUNCH",
        "authorized_official_first_name": "JACQUELIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "984-989-7361"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "34D2236826",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carmesia Jackson
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• Andre Jakewell
• Jannie'S Ride Inc
• Jason R. Harris DDS, PA
• Thomas Walker Jenkins, PA-C

• Clinical Medical Laboratory in Clayton, NC
• Providers in Clayton, NC by specialty
• Clinical Medical Laboratory in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; 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.