MEDICARE: MRS. LAURIE DRISCOLL PA-C

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	363AS0400X	Surgical Physician Assistant	0001-01271	NC
2	363A00000X	Physician Assistant	0001-01271	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970014813	OTHER	NC	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1457338915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE DRISCOLL PA-C

Provider Business Mailing Address
First Line	:	PO BOX 751069
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1069
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 MOYE BLVD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-4300
Country	:	US
Telephone Number	:	252-744-2335
Fax Number	:	252-744-3811

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	02/13/2026

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