Healthcare Provider Details

I. General information

NPI: 1669459459
Provider Name (Legal Business Name): AIMEE BUCK KERCHNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AIMEE OLIVIA BUCK PA-C

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 10/28/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 RANDOLPH RD
CHARLOTTE NC
28207-1101
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-5420
  • Fax: 704-384-5424
Mailing address:
  • Phone: 704-384-5420
  • Fax: 704-384-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number102969
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-00303
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: