Healthcare Provider Details

I. General information

NPI: 1366067548
Provider Name (Legal Business Name): PRATHNA PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 VILLAGE DR
FAYETTEVILLE NC
28304-3978
US

IV. Provider business mailing address

6808 THAMES DR
FAYETTEVILLE NC
28306-2524
US

V. Phone/Fax

Practice location:
  • Phone: 910-486-5700
  • Fax:
Mailing address:
  • Phone: 910-494-6665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: