Healthcare Provider Details

I. General information

NPI: 1366068629
Provider Name (Legal Business Name): AMY LEEANNE CAIRNS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 WATERS EDGE DR STE 100
RALEIGH NC
27606-2462
US

IV. Provider business mailing address

4909 WATERS EDGE DR
RALEIGH NC
27606-2462
US

V. Phone/Fax

Practice location:
  • Phone: 919-589-1204
  • Fax: 919-589-1264
Mailing address:
  • Phone: 919-589-1204
  • Fax: 919-589-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-10279
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: