JACK LLORRAC BAGLEY (NPI# 1083653745) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083653745 |
| Entity Type | Individual |
| Full Name | JACK LLORRAC BAGLEY |
| Credential | PA-C |
| Practice Address |
2208 S 17th St Wilmington NC 28401-7593 |
| Practice Telephone | 9107633333 |
| Mailing Telephone | 9107633333 |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2013-03-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 2006004610 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225355670 | Jack Ryan Bagley | Radiology | 2596 F Rd, Grand Junction, CO 81505-1443 | 2010-04-26 |
| Street Address |
2208 S 17TH ST |
| City | WILMINGTON |
| State | NC |
| Zip Code | 28401-7593 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487626560 | George Van Buren Huffmon IIi | Specialist | 2208 S 17th St, Suite 201, Wilmington, NC 28401-7515 | 2006-02-03 |
| 1306307764 | Robin Rhyne Mclawhorn | Nurse Practitioner | 2208 S 17th St, Wilmington, NC 28401-7593 | 2019-03-28 |
| 1568844595 | Maria Luisa Stoute | Nurse Practitioner | 2208 S 17th St, Suite 201, Wilmington, NC 28401-7593 | 2015-06-26 |
| 1942621628 | Sheila Kubes | Physician Assistant | 2208 S 17th St, Wilmington, NC 28401 | 2013-12-23 |
| 1730514647 | Matthew Mcrae Spicer | Physician Assistant | 2208 S 17th St, Wilmington, NC 28401-7593 | 2013-09-10 |
| 1578848735 | Laura Ann Ivey | Physician Assistant | 2208 S 17th St, Wilmington, NC 28401-7593 | 2011-10-19 |
| 1891927620 | Rebecca Eileen Noell | Nurse Practitioner | 2208 S 17th St, Wilmington, NC 28401-7593 | 2009-08-12 |
| 1780835769 | John Alexander Thomas | Neurological Surgery | 2208 S 17th St, Suite 201, Wilmington, NC 28401-7593 | 2008-10-08 |
| 1679765648 | Anna Peacock Bettendorf | Physical Medicine & Rehabilitation | 2208 S 17th St, Second Floor, Wilmington, NC 28401-7593 | 2007-08-14 |
| 1134236078 | Peacock-bettendorf, LLC | Physical Medicine & Rehabilitation | 2208 S 17th St, Second Floor, Wilmington, NC 28401-7515 | 2006-08-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275002461 | Thrivetothrive, LLC | Physical Therapist | 1606 Physicians Drive, Inside Promina Health, Wilmington, NC 28401 | 2018-11-16 |
| 1841787454 | Kevin Christopher Panebianco | Family Medicine | 1911 S 17th St Ste 130a, Wilmington, NC 28401 | 2018-04-18 |
| 1518472588 | Michelle Bruin | Family Medicine | 415 S. 2nd Street, Wilmington, NC 28401 | 2017-12-12 |
| 1639617343 | Anna Farwell | Behavior Technician | 3904 Oleander Dr. Suite 102, Wilmington, NC 28401 | 2017-02-02 |
| 1588034144 | Dimitri Zivko Pitovski | Allergy & Immunology | 1099 Medical Center Dr Unit 100b, Wilmington, NC 28401 | 2015-09-25 |
| 1629457007 | Megan Havel | Counselor | 1512 E Lakeshore Drive, Wilmington, NC 28401 | 2015-05-19 |
| 1154709251 | Lance Hutchens | Dentist | 1611 Doctors Cir, Wilmington, NC 28401 | 2015-05-11 |
| 1609281161 | Diane Pittman Whitford | Counselor | 313 Walnut St., Wilmington, NC 28401 | 2014-06-24 |
| 1942550728 | Bryan Cole Chalk | Nurse Anesthetist, Certified Registered | 2131 S 17th Street, Wilmington, NC 28401 | 2012-09-19 |
| 1740566546 | Valerie Baars | Pharmacist | 2302 S 17th Street, Wilmington, NC 28401 | 2011-10-25 |
| Find all providers in zip 28401 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750990461 | Kyra Isaacs | Physician Assistant | 1901 Greenbriar Dr, Wilmington, DE 19810-4320 | 2020-07-28 |
| 1144847252 | Stephanie Marie Barczak | Physician Assistant | 11 Amherst Rd, Wilmington, MA 01887-2608 | 2020-07-06 |
| 1457984676 | Jessica Patrick Lancaster | Physician Assistant | 602 Jennings Dr, Wilmington, NC 28403-2732 | 2020-02-17 |
| 1730727348 | Lea Ann Cenname | Physician Assistant | 722 Mohican Trl, Wilmington, NC 28409-3429 | 2019-12-13 |
| 1467944645 | Julie Renee Sims | Physician Assistant | 3411 Silverside Rd Ste 107, Wilmington, DE 19810-4806 | 2018-06-04 |
| 1740780865 | Greater Tomorrow Wellness, LLC | Physician Assistant | 1097 W Locust St, Wilmington, OH 45177 | 2018-02-15 |
| 1336658657 | Eric Dees | Physician Assistant | 501 W 14th St Fl 1, Wilmington, DE 19801-1013 | 2017-09-29 |
| 1174047591 | Carlie M Black | Physician Assistant | 4815 Oleander Dr Ste 100, Wilmington, NC 28403-5116 | 2017-07-27 |
| 1497294581 | Kathleen Lauren Meyer | Physician Assistant | 6419 Carolina Beach Rd Ste A, Wilmington, NC 28412-3672 | 2017-02-22 |
| 1477090967 | David Romano | Physician Assistant | 15 Kilmarnock St, Wilmington, MA 01887-3061 | 2017-01-23 |
| Find all providers in WILMINGTON | ||||
| City | WILMINGTON |
| Zip Code | 28401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.