Healthcare Provider Details

I. General information

NPI: 1649778101
Provider Name (Legal Business Name): NATASHA RUDD BROWN PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATASHA RUDD PHYSICIAN ASSISTANT

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 E 7TH ST
CHARLOTTE NC
28204-4318
US

IV. Provider business mailing address

2630 E 7TH ST STE 200
CHARLOTTE NC
28204-4319
US

V. Phone/Fax

Practice location:
  • Phone: 704-364-6110
  • Fax:
Mailing address:
  • Phone: 704-364-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-07745
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: