Jena W. Nickles, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

1585 Issued in SC

Practice address

180 Wingo Way
Suite 301
Mt Pleasant, SC 29464-1810

Phone

(843) 884-0302

Fax

(843) 849-9308

NPI assigned

Nov 3, 2010

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

Other identifiers 1

Other names 1

• Jena M. Weaver Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1288742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485216000000",
    "number": "1821399106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751649",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751649",
            "telephone_number": "843-789-1620",
            "fax_number": "843-724-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 WINGO WAY",
            "address_2": "SUITE 301",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294641810",
            "telephone_number": "843-884-0302",
            "fax_number": "843-849-9308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKLES",
        "first_name": "JENA",
        "middle_name": "W.",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-03",
        "last_updated": "2017-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SC",
            "license": "1585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1076PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENA",
            "last_name": "WEAVER",
            "middle_name": "M.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Minhthu Nguyen
• Viet Nguyen
• NH VCN Virtual Primary Care LLC (Novant Health Virtual Primary Care)
• Amber Joy Nicholson, PTA
• Jacqueline Nickel, MS CCC SLP
• Nicole Dahlkemper, DMD, PC
• Bethaney Nielsen, DPT
• Hailey G Nies, SLP
• Nirvana Wellness (Atlas Spine and Wellness Care)
• Meghan Patton Nix, PA-C

• Surgical Physician Assistant in Mount Pleasant, SC
• Providers in Mount Pleasant, SC by specialty
• Surgical Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 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.

Verify at the official NPI Registry.