Healthcare Provider Details

I. General information

NPI: 1194759563
Provider Name (Legal Business Name): ANN MARIE SKINNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 LEROY GEORGE DR
CLYDE NC
28721-7430
US

IV. Provider business mailing address

262 LEROY GEORGE DRIVE
CLYDE NC
28716
US

V. Phone/Fax

Practice location:
  • Phone: 828-452-8110
  • Fax:
Mailing address:
  • Phone: 828-452-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1483
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-02005
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: