Healthcare Provider Details

I. General information

NPI: 1942912845
Provider Name (Legal Business Name): MELANIE JO KIJOWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELANIE JO MARKOVIC PA-C

II. Dates (important events)

Enumeration Date: 12/22/2022
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1484 DALE EARNHARDT BLVD STE 112
KANNAPOLIS NC
28083-3206
US

IV. Provider business mailing address

6012 BAYFIELD PKWY # 402
CONCORD NC
28027-7597
US

V. Phone/Fax

Practice location:
  • Phone: 704-486-8189
  • Fax:
Mailing address:
  • Phone: 704-486-8189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13314
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: