Provider Demographics
NPI:1295027845
Name:SEGEBARTH, KIRA MOLLENKOPF (RD, CPNP)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:MOLLENKOPF
Last Name:SEGEBARTH
Suffix:
Gender:F
Credentials:RD, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 VERNON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1720
Mailing Address - Country:US
Mailing Address - Phone:704-960-9178
Mailing Address - Fax:
Practice Address - Street 1:4501 CAMERON VALLEY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4297
Practice Address - Country:US
Practice Address - Phone:704-512-5836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005172363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004940Medicaid
SCNP1835Medicaid
SCNP1835Medicaid