MEDICARE: KENYATTA PRATT

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	246RM2200X	Medical Laboratory Technician		NC

General Provider Information

NPI Number	:	1457218901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYATTA PRATT

Provider Business Mailing Address
First Line	:	8322 PINEVILLE MATTHEWS RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4707
Country	:	US
Telephone Number	:	704-517-1123
Fax Number	:	704-517-1123

Provider Business Practice Location Address
First Line	:	8322 PINEVILLE MATTHEWS RD
Second Line	:	602-1052
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4707
Country	:	US
Telephone Number	:	704-517-1123
Fax Number	:	704-517-1123

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

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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Directions to “ KENYATTA PRATT ” Practice Location

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