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General NPI Number Information
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NPI Number | 1063567626
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Entity Type | Individual
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Provider Name | KACIE MILLER TEETER PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 310 DAVIE AVE STATESVILLE FAMILY PRACTICE
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City | STATESVILLE
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State | NC
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Zip | 28677-5319
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Country | US
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Telephone | 704-873-3269
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Fax | 704-871-8159
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Provider Business Mailing Address
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Address Line | PO BOX 896199 STATESVILLE FAMILY PRACTICE
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City | CHARLOTTE
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State | NC
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Zip | 28289-5319
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Country | US
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Telephone | 833-936-1364
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Fax | 605-942-7505
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 001000789
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License Number State | NC
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