Provider Demographics
NPI:1588634372
Name:MORRIS, CHARLENE MCCLURE (PAC)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:MCCLURE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BAYBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28515
Mailing Address - Country:US
Mailing Address - Phone:252-745-3191
Mailing Address - Fax:252-745-7385
Practice Address - Street 1:606 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BAYBORO
Practice Address - State:NC
Practice Address - Zip Code:28515
Practice Address - Country:US
Practice Address - Phone:252-745-3191
Practice Address - Fax:252-745-7385
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102020363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCH886CMedicare PIN
NCS24973Medicare UPIN