Provider Demographics
NPI:1982628145
Name:PLEASANT, KARL ANTHONY (PA-C)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:ANTHONY
Last Name:PLEASANT
Suffix:
Gender:M
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 1:2025 FRONTIS PLAZA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5663
Mailing Address - Country:US
Mailing Address - Phone:336-768-6211
Mailing Address - Fax:336-768-6869
Practice Address - Street 1:2025 FRONTIS PLAZA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5663
Practice Address - Country:US
Practice Address - Phone:336-768-6211
Practice Address - Fax:336-768-6869
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00514363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-00514OtherSTATE LICENSE
NCP00454356OtherRR MEDICARE
Q71589Medicare UPIN
2766821Medicare PIN