Healthcare Provider Details

I. General information

NPI: 1912155409
Provider Name (Legal Business Name): STEPHANIE MARIE MICHEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MEDICAL PARK RD STE 205
MOORESVILLE NC
28117-8541
US

IV. Provider business mailing address

PO BOX 1845
STATESVILLE NC
28687-1845
US

V. Phone/Fax

Practice location:
  • Phone: 704-663-5056
  • Fax: 704-663-5780
Mailing address:
  • Phone: 704-873-4277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-01466
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: