Healthcare Provider Details

I. General information

NPI: 1851556898
Provider Name (Legal Business Name): EMILEE JO RANGEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILEE JO EDEN PA-C

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PARK DR STE 400
CONCORD NC
28025-0906
US

IV. Provider business mailing address

200 MEDICAL PARK DR STE 400
CONCORD NC
28025-0906
US

V. Phone/Fax

Practice location:
  • Phone: 704-786-1108
  • Fax: 704-782-1826
Mailing address:
  • Phone: 704-786-1108
  • Fax: 704-782-1826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0010-01382
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001001382
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: