Provider Demographics
NPI:1255497616
Name:BIGELMAN, MICHELLE BARDY (PAC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:BARDY
Last Name:BIGELMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:BETH
Other - Last Name:BARDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C;MMS
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-288-8857
Mailing Address - Fax:336-288-8769
Practice Address - Street 1:1941 NEW GARDEN RD
Practice Address - Street 2:SUITE 216
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2554
Practice Address - Country:US
Practice Address - Phone:336-288-8857
Practice Address - Fax:336-288-8769
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102613363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant