Healthcare Provider Details

I. General information

NPI: 1376715763
Provider Name (Legal Business Name): AIMEE SHAYE POLK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5212 N COLLEGE RD UNIT B
CASTLE HAYNE NC
28429-6016
US

IV. Provider business mailing address

5212 N COLLEGE RD UNIT B
CASTLE HAYNE NC
28429-6016
US

V. Phone/Fax

Practice location:
  • Phone: 910-675-0333
  • Fax: 910-675-0833
Mailing address:
  • Phone: 910-675-0333
  • Fax: 910-675-0833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-01307
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: