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NPI Code Detail

MEDICARE: MOLLY MCKNIGHT TAPPAN

MEDICARE: MOLLY MCKNIGHT TAPPAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2363A00000XPhysician Assistant0010-15327NC

General Provider Information

NPI Number : 1003651365
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY MCKNIGHT TAPPAN
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 125 QUEENS RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-3278
Country : US
Telephone Number : 803-026-5009
Fax Number : 980-302-6505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2024
Last Update Date : 06/16/2025

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Directions to “ MOLLY MCKNIGHT TAPPAN ” Practice Location

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