Provider Demographics
NPI:1043296817
Name:CUMMINS, MARY M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:M
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:704-316-5070
Mailing Address - Fax:704-316-5075
Practice Address - Street 1:3810 SPRINGHURST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6162
Practice Address - Country:US
Practice Address - Phone:502-583-1749
Practice Address - Fax:502-329-7599
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101970Medicaid
NCNC2522LMedicare PIN
NCNC2522BMedicare PIN
NC8101970Medicaid
NCNC2522FMedicare PIN
NCNC2522CMedicare PIN
NCNC2522AMedicare PIN
NCQ33751Medicare UPIN
NCNC2522KMedicare PIN
NCNC2522NMedicare PIN
NCNC2522EMedicare PIN
NCNC2522GMedicare PIN
NCNC2522IMedicare PIN
NCNC2522DMedicare PIN
NCNC2522HMedicare PIN
NCNC2522MMedicare PIN