Jonathan Roberts Haller, DSC, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

61085816 Issued in WA

Practice address

2817 Rock Merritt Ave
Fort Bragg, NC 28310-0001

Phone

(910) 907-8922

NPI assigned

Mar 8, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1299542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762214400000",
    "number": "1164720686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERRITT AVE",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283100001",
            "telephone_number": "910-907-8922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERRITT AVE",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283100001",
            "telephone_number": "910-907-8922"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9040 Jackson Ave",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984310001",
            "country_code": "US",
            "telephone_number": "253-968-3885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HALLER",
        "first_name": "JONATHAN",
        "middle_name": "ROBERTS",
        "credential": "DSC, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-08",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "61085816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jesse McRae Hall, PA-C
• Jesse Park Hall, D.D.S.
• Joshua Lee Hall, DDS
• Kaci Synclaire Hall
• Teresa I Hall, RN
• Carly Halley, AUD
• Julia Scott Halsey
• Bertha Bowen Hambidge, MD
• Jackie Hammelman, PHD CLINICAL PSYCHOL
• Jordan Erika Hammermueller, PA-C

• Surgical Physician Assistant in Fort Bragg, NC
• Providers in Fort Bragg, NC by specialty
• Surgical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; 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.