Active NPI
Holly Lauren Deaver, PA-C
- Physician Assistant
- Jacksonville, NC
National Provider Identifier
1790224533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-07065
- Practice address
- 308 Dolphin Dr
Jacksonville, NC 28546-5266 - Phone
- (910) 346-2273
- Fax
- (910) 346-1907
- NPI assigned
- Feb 13, 2017
- 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 | 0010-07065 | NC | Primary |
Addresses
Primary practice location
308 Dolphin Dr
Jacksonville, NC 28546-5266
Mailing address
410 Tempo TRL
Richlands, NC 28574-8481
Phone (828) 400-5095
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-07065 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486944000000",
"number": "1790224533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 TEMPO TRL",
"city": "RICHLANDS",
"state": "NC",
"postal_code": "285748481",
"telephone_number": "828-400-5095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 DOLPHIN DR",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285465266",
"telephone_number": "910-346-2273",
"fax_number": "910-346-1907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEAVER",
"first_name": "HOLLY",
"middle_name": "LAUREN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-13",
"last_updated": "2017-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-07065",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.