Jacqueline Carroll, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

104116 Issued in NC

Practice address

510 Carolina Bay Dr
Ste 110
Wilmington, NC 28403-2041

Phone

(910) 662-6000

NPI assigned

Sep 27, 2006

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Health Sciences Foundation Inc.

  • Internal Medicine Physician
  • Wilmington, NC
  • NPI 1942288600
  NPD (past)
• New Hanover Regional Medical Center

  • Internal Medicine Physician
  • Wilmington, NC
  • NPI 1952705519
  NPD (past)
• Wilmington Health PLLC

  • Multi-Specialty Clinic/Center
  • Wilmington, NC
  • NPI 1881632339
  NPD (past)

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1508957663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 CAROLINA BAY DR",
            "address_2": "STE 110",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284032041",
            "telephone_number": "910-662-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1960 S 16th St",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284016676",
            "country_code": "US",
            "telephone_number": "910-343-9991",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5145 S College Rd",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284122207",
            "country_code": "US",
            "telephone_number": "910-792-1144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7910 US Hwy 117 S",
            "address_2": "Unit 120",
            "address_purpose": "LOCATION",
            "city": "Rocky Point",
            "state": "NC",
            "postal_code": "284579431",
            "country_code": "US",
            "telephone_number": "910-300-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7420 Market St",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284119453",
            "country_code": "US",
            "telephone_number": "910-686-2525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JACQUELINE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2021-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "104116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "510 Carolina Bay Dr",
            "address_2": "Ste 110",
            "city": "Wilmington",
            "state": "NC",
            "country_code": "US",
            "postal_code": "284032041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christina Joy Carradine, LCSW
• Isabella Carrasco, RBT
• Olivia Marie Carriger, NP
• Bobby Eugene Carroll Jr., PHARMD
• Bridget Carroll
• James Murray Carroll, R.PH.
• Katelyn Michelle Carroll
• Nicole Carroll, MD
• Renn Williams Carroll, M.S., CCC-SLP
• Sheri Lynn Carroll, MD

• Physician Assistant in Wilmington, NC
• Providers in Wilmington, 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 Jan 20, 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.