Provider Demographics
NPI:1033445879
Name:KLITCH, CHERRYL LAI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHERRYL
Middle Name:LAI
Last Name:KLITCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CHERRYL
Other - Middle Name:K
Other - Last Name:LAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9600 E INDEPENDENCE BLVD STE B
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4628
Practice Address - Country:US
Practice Address - Phone:704-815-5624
Practice Address - Fax:704-815-5621
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105052363AM0700X
NC0010-06921363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical