MEDICARE: KIRSTA L NORWOOD PAC

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
1	207Q00000X	Family Medicine Physician	0010-01603	NC
2	363A00000X	Physician Assistant	0010-1603	NC

General Provider Information

NPI Number	:	1437262383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTA L NORWOOD PAC

Provider Business Mailing Address
First Line	:	10620 PARK RD STE 202
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-0106
Country	:	US
Telephone Number	:	704-512-3988
Fax Number	:

Provider Business Practice Location Address
First Line	:	10620 PARK RD STE 202
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-0106
Country	:	US
Telephone Number	:	704-512-3988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	10/08/2024

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