Healthcare Provider Details

I. General information

NPI: 1053039800
Provider Name (Legal Business Name): KATHERINE E SAUVAGEOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11430 RED RUST LN STE 201
CHARLOTTE NC
28277-4948
US

IV. Provider business mailing address

13808 PROFESSIONAL CENTER DR
HUNTERSVILLE NC
28078-7948
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-4009
  • Fax:
Mailing address:
  • Phone: 304-730-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1053039800
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-14327
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: