Healthcare Provider Details

I. General information

NPI: 1568661916
Provider Name (Legal Business Name): PATRICIA YABES SKULAVIK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 TILGHMAN DRIVE SUITE 728
DUNN NC
28334
US

IV. Provider business mailing address

700 TILGHMAN DRIVE SUITE 728
DUNN NC
28334
US

V. Phone/Fax

Practice location:
  • Phone: 910-897-7806
  • Fax: 910-897-6804
Mailing address:
  • Phone: 910-897-7806
  • Fax: 910-897-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-02033
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-02033
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: