MEDICARE: KATHLEEN HAYES PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	103463	NC

General Provider Information

NPI Number	:	1407822273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN HAYES PAC

Provider Business Mailing Address
First Line	:	6300 TRIPP PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0103
Country	:	US
Telephone Number	:	704-577-5656
Fax Number	:	704-544-0357

Provider Business Practice Location Address
First Line	:	6300 TRIPP PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0103
Country	:	US
Telephone Number	:	704-577-5656
Fax Number	:	704-544-0357

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	02/13/2013

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