Provider Demographics
NPI:1023050887
Name:FARMER, ELISSA NOEL (PA-C)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:NOEL
Last Name:FARMER
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 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:
Practice Address - Street 1:645 AMALIA STREET, NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2434
Practice Address - Country:US
Practice Address - Phone:704-295-3255
Practice Address - Fax:704-295-3279
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103664363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01131698OtherMEDICARE - RAILROAD
NC164XGOtherBCBSNC
7125423OtherAETNA
SC833405OtherWELLCARE
NC8102401Medicaid
SC1251PAMedicaid
P83894Medicare UPIN
SC1251PAMedicaid