Healthcare Provider Details

I. General information

NPI: 1235877382
Provider Name (Legal Business Name): CAROLYN PROVIDENCE UPCHURCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 HOSPITAL RD STE C
SYLVA NC
28779-5195
US

IV. Provider business mailing address

293 HOSPITAL RD STE C
SYLVA NC
28779-5195
US

V. Phone/Fax

Practice location:
  • Phone: 828-631-8711
  • Fax:
Mailing address:
  • Phone: 828-631-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12455
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA6415
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: