Provider Demographics
NPI:1538196514
Name:BATTS, JENNAH D (C-AA)
Entity type:Individual
Prefix:MRS
First Name:JENNAH
Middle Name:D
Last Name:BATTS
Suffix:
Gender:F
Credentials:C-AA
Other - Prefix:
Other - First Name:JENNAH
Other - Middle Name:ELIZABETH
Other - Last Name:DILDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:C-AA
Mailing Address - Street 1:2080 W ARLINGTON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3770
Mailing Address - Country:US
Mailing Address - Phone:252-752-2140
Mailing Address - Fax:252-689-6502
Practice Address - Street 1:2080 W ARLINGTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-752-2140
Practice Address - Fax:252-689-6502
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1000-00190367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8000504Medicaid
NCP00742942OtherRAILROAD MEDICARE
NC1538196514OtherTRICARE - NORTH REGION
NC1538196514OtherTRICARE - NORTH REGION