Healthcare Provider Details

I. General information

NPI: 1700407038
Provider Name (Legal Business Name): CAROLINA ROBERTA DRAPER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 MOREHEAD MEDICAL DR STE A
CHARLOTTE NC
28204-2990
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 980-442-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11004
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: