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General NPI Number Information
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NPI Number | 1629841697
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Entity Type | Organization
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Legal Business Name | TWENTY-ONE MEDICAL PLLC
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Dates
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Enumeration Date | 11/01/2023
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 11940 CAROLINA PLACE PKWY STE 100
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City | PINEVILLE
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State | NC
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Zip | 28134-7471
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Country | US
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Telephone | 704-578-7273
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Fax |
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Provider Business Mailing Address
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Address Line | 11940 CAROLINA PLACE PKWY STE 100
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City | PINEVILLE
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State | NC
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Zip | 28134-7471
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Country | US
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Telephone | 704-578-7273
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAWN OKEEFE
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Credential | PA-C
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Telephone | 704-578-7273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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