Provider Demographics
NPI: | 1184628745 |
---|---|
Name: | KLEIN, PATRICIA MILLS (PA-C) |
Entity Type: | Individual |
Prefix: | |
First Name: | PATRICIA |
Middle Name: | MILLS |
Last Name: | KLEIN |
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: | 1701 WESTCHESTER DR |
Mailing Address - Street 2: | STE 850 |
Mailing Address - City: | HIGH POINT |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27262-7254 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 336-802-2400 |
Mailing Address - Fax: | 336-802-2001 |
Practice Address - Street 1: | 3333 BROOKVIEW HILLS BLVD |
Practice Address - Street 2: | STE 207 |
Practice Address - City: | WINSTON-SALEM |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27103-5661 |
Practice Address - Country: | US |
Practice Address - Phone: | 336-765-5250 |
Practice Address - Fax: | 336-659-0953 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-06-10 |
Last Update Date: | 2009-06-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 101115 | 363AM0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | P00391426 | Other | RR MEDICARE |
NC | 101115 | Other | MEDICAL LICENSE |
NC | 101115 | Other | MEDICAL LICENSE |
R75155 | Medicare UPIN |