MEDICARE: LYNN STYERS GILBERT 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	363A00000X	Physician Assistant	0010-04976	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0010-04976	OTHER	NC	NC MEDICAL LICENSE

General Provider Information

NPI Number	:	1528001914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN STYERS GILBERT PA-C

Provider Business Mailing Address
First Line	:	4601 PARK RD
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3239
Country	:	US
Telephone Number	:	704-323-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 STATE FARM RD STE 200
Second Line	:
City	:	BOONE
State	:	NC
Zip	:	28607-5021
Country	:	US
Telephone Number	:	704-323-2000
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	11/07/2017

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