Jennifer Kelly Williams Carroll, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-01533 Issued in NC

Practice address

612 Mocksville Ave
Rowan Regional Medical Center- Novant Health
Salisbury, NC 28144-8402

Phone

(704) 644-9290

NPI assigned

Sep 29, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Regional Emergency Physicians PA

  • Emergency Medicine Physician
  • High Point, NC
  • NPI 1154426294
  NPD (past)

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

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412899200000",
    "number": "1205086006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 MOCKSVILLE AVE",
            "address_2": "ROWAN REGIONAL MEDICAL CENTER- NOVANT HEATH",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281448402",
            "telephone_number": "704-644-9290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 MOCKSVILLE AVE",
            "address_2": "ROWAN REGIONAL MEDICAL CENTER- NOVANT HEALTH",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281448402",
            "telephone_number": "704-644-9290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JENNIFER",
        "middle_name": "KELLY WILLIAMS",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-29",
        "last_updated": "2014-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-01533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolinas Physicians Network, Inc.
• Kelly Bergeron Carpenter, NP-C
• Sierra Dawn Carpenter, AUD
• Jordan Carrillo
• Danielle Carrington
• Dakhari U Carter
• Eulishia Carter
• Jeffrey Carter, ED.S
• Mary Casey
• Robert Casmus, LAT, ATC

• Physician Assistant in Salisbury, NC
• Providers in Salisbury, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2014; 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.