Healthcare Provider Details

I. General information

NPI: 1235784869
Provider Name (Legal Business Name): MICHELLE STEPHANY MARTINEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S MAIN ST
BOILING SPRINGS NC
28017-9797
US

IV. Provider business mailing address

102 W 1ST AVE STE C
LEXINGTON NC
27292-3695
US

V. Phone/Fax

Practice location:
  • Phone: 714-381-4133
  • Fax:
Mailing address:
  • Phone: 704-237-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-10442
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-10442
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: