Healthcare Provider Details

I. General information

NPI: 1255082442
Provider Name (Legal Business Name): CHLOE PAPA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 ASHTON DR
WILMINGTON NC
28412-2489
US

IV. Provider business mailing address

3605 BEVERLY COVE WAY APT 301
WILMINGTON NC
28412-0821
US

V. Phone/Fax

Practice location:
  • Phone: 910-332-3800
  • Fax:
Mailing address:
  • Phone: 304-444-7423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-13373
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: