Active NPI
Jenna Staples, PA-C
- Physician Assistant
- Durham, NC
National Provider Identifier
1225430127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-05217
- Practice address
- 1301 Fayetteville Street
Durham, NC 27717 - Phone
- (919) 956-4000
- NPI assigned
- Sep 23, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0010-05217 | NC | Primary |
Addresses
Primary practice location
1301 Fayetteville Street
Durham, NC 27717
Mailing address
803 Demerius St Apt H3
Durham, NC 27701-1661
Phone (919) 308-6518
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-05217 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411430400000",
"number": "1225430127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "803 DEMERIUS ST APT H3",
"city": "DURHAM",
"state": "NC",
"postal_code": "277011661",
"telephone_number": "919-308-6518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 FAYETTEVILLE STREET",
"city": "DURHAM",
"state": "NC",
"postal_code": "27717",
"telephone_number": "919-956-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAPLES",
"first_name": "JENNA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-23",
"last_updated": "2014-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-05217",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.