Healthcare Provider Details

I. General information

NPI: 1306522016
Provider Name (Legal Business Name): RACHEL JEAN ROBERTS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 LAKESHORE PKWY
ROCK HILL SC
29730-4205
US

IV. Provider business mailing address

107 HIDDEN PASTURES DR
CRAMERTON NC
28032-1640
US

V. Phone/Fax

Practice location:
  • Phone: 803-909-6363
  • Fax:
Mailing address:
  • Phone: 704-968-0024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13362
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: