Provider Demographics
NPI:1801814124
Name:PADGETT, MARY KATRINA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATRINA
Last Name:PADGETT
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 1:11491 US HIGHWAY 70 W
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2207
Mailing Address - Country:US
Mailing Address - Phone:919-550-2484
Mailing Address - Fax:919-550-7059
Practice Address - Street 1:11491 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2207
Practice Address - Country:US
Practice Address - Phone:919-550-2484
Practice Address - Fax:919-550-7059
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102873363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00774Medicare UPIN
NC2752762BMedicare PIN