Provider Demographics
NPI:1417133166
Name:EDGERTON, ANN KILLIAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:KILLIAN
Last Name:EDGERTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:423 S SHARON AMITY RD STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2974
Mailing Address - Country:US
Mailing Address - Phone:704-333-4817
Mailing Address - Fax:704-333-4879
Practice Address - Street 1:423 S SHARON AMITY RD STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2974
Practice Address - Country:US
Practice Address - Phone:704-333-4817
Practice Address - Fax:704-333-4879
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100356363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant