Provider Demographics
NPI:1376715763
Name:POLK, AIMEE SHAYE (PA-C)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:SHAYE
Last Name:POLK
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 1:5212 N COLLEGE RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:CASTLE HAYNE
Mailing Address - State:NC
Mailing Address - Zip Code:28429-6016
Mailing Address - Country:US
Mailing Address - Phone:910-675-0333
Mailing Address - Fax:910-675-0833
Practice Address - Street 1:5212 N COLLEGE RD
Practice Address - Street 2:UNIT B
Practice Address - City:CASTLE HAYNE
Practice Address - State:NC
Practice Address - Zip Code:28429-6016
Practice Address - Country:US
Practice Address - Phone:910-675-0333
Practice Address - Fax:910-675-0833
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01307363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical