Millicent Calena Jennette, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

103905 Issued in NC

Practice address

2035 Valleygate Dr
Suite 101
Fayetteville, NC 28304-3984

Phone

(910) 484-8009

Fax

(910) 484-2205

NPI assigned

May 27, 2008

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

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Cumberland County Health Dept

  • Public Health or Welfare Agency
  • Fayetteville, NC
  • NPI 1831249986
  Medicare reassignment
• Cross Creek Pediatrics

  • Specialist
  • Fayetteville, NC
  • NPI 1831279215
  NPD (past)

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

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211846400000",
    "number": "1760640841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2035 VALLEYGATE DR",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043984",
            "telephone_number": "910-484-8009",
            "fax_number": "910-484-2205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2035 VALLEYGATE DR",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043984",
            "telephone_number": "910-484-8009",
            "fax_number": "910-484-2205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNETTE",
        "first_name": "MILLICENT",
        "middle_name": "CALENA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-27",
        "last_updated": "2008-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Lawrence Jenkins
• Kay Baker Jenkins, MSN
• Lakisha Jenkins, RBT
• Robert H Jenkins, PH.D.
• Christina Main Jenks, LICENSED MASS.TH.
• Julianna Jennings
• Jenny & Marv'S Transportation Angels
• Blanche Coleman Jensen
• John Victor Jensen, LCMHC
• Jeremiah C Davis, DDS, Mba, PA

• Physician Assistant in Fayetteville, NC
• Providers in Fayetteville, 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 May 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.