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Jennifer Marie Short

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

13845 Conlan Cir, Charlotte, NC 28277-2705

(704) 544-2092

PECOS Enrollment

This provider is enrolled in PECOS as JENNIFER SHORT.

Based on the most recent information from CMS, provider Jennifer Marie Short is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 34 days ago.

Profile Details

Provider ID
1750617874
Provider Type
Individual
Full Name
Short, Jennifer Marie
Credential
P.A.-C

Gender
Female
Sole Proprietor
No
Enumeration Date
10/23/2009
Last Updated
10/2/2017

Contact Information

Practice Location

13845 Conlan Cir, Charlotte, NC 28277-2705

(704) 544-2092

Unlisted Fax

Mailing Location

13845 Conlan Circle, Charlotte, NC 28277-0060

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 001002003 North Carolina
Code 363AM0700X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 0010-02003 North Carolina

Jennifer Marie Short

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Miller, Samantha Marie

Sheldon, Jennifer Shields

Donnalley, Kayla Christine

O'Brien, Sharon Mcvay

Patel, Hershal

Tram, Kaylie

O'Connor, William Charles

Mencel, Johanna Elizabeth Hughes

Moorhouse, Ryan Louis

Seegers, Jeffrey Allen