Healthcare Provider Details

I. General information

NPI: 1720719032
Provider Name (Legal Business Name): BRAELYN JEWELL LAHAIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 JAKE ALEXANDER BLVD W
SALISBURY NC
28147-1364
US

IV. Provider business mailing address

2243 OAKHURST CT
KANNAPOLIS NC
28081-7136
US

V. Phone/Fax

Practice location:
  • Phone: 704-633-5605
  • Fax: 704-637-2351
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12928
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: