Healthcare Provider Details

I. General information

NPI: 1689502379
Provider Name (Legal Business Name): LAURA KATHERINE PACE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 RANDOLPH RD STE 300
CHARLOTTE NC
28207-1112
US

IV. Provider business mailing address

2025 CLEVELAND AVE APT 511
CHARLOTTE NC
28203-7076
US

V. Phone/Fax

Practice location:
  • Phone: 704-364-8100
  • Fax: 704-365-2073
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16540
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: