Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jason Michael Licht, PA-C

Individual provider Medical Physician Assistant · NPI 1073533410

Jason Michael Licht, PA-C is a Physician Assistant in Raleigh, North Carolina. Qualified in 2003, 23 years ago. Practices with Wakemed Specialists Group LLC, a 869-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
23
Licensed in
NC
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3000 New Bern Ave Ste 1200
Raleigh, NC 27610-1231
Phone: (919) 231-6132
Fax: (919) 231-6276
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-00069 (NC)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 0010-00069 (NC)

Record details

NPI number1073533410
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedJuly 20, 2006
Last updated in NPPESMarch 27, 2023
Certification dateMarch 27, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2003 (23 years in practice)
Group practice Wakemed Specialists Group Llc — 869 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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