MEDICARE: MRS. REBEKAH ANNE STOCKSTILL 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	363AM0700X	Medical Physician Assistant	005266	GA
2	363A00000X	Physician Assistant	0010-03802	NC
3	363AM0700X	Medical Physician Assistant	2435	SC

General Provider Information

NPI Number	:	1508036518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBEKAH ANNE STOCKSTILL PA-C

Provider Business Mailing Address
First Line	:	8700 PINEVILLE MATTHEWS RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4750
Country	:	US
Telephone Number	:	886-451-3467
Fax Number	:	855-238-6036

Provider Business Practice Location Address
First Line	:	8700 PINEVILLE MATTHEWS RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4750
Country	:	US
Telephone Number	:	866-451-3467
Fax Number	:	855-238-6036

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

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	03/19/2019

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