Provider Demographics
NPI:1295180206
Name:MAYERS, CARI SUSANN (PA)
Entity type:Individual
Prefix:
First Name:CARI
Middle Name:SUSANN
Last Name:MAYERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CARI
Other - Middle Name:SUSANN
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 COMMERCE PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7386
Mailing Address - Country:US
Mailing Address - Phone:910-521-2900
Mailing Address - Fax:910-775-9165
Practice Address - Street 1:307 E WARDELL DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372
Practice Address - Country:US
Practice Address - Phone:910-521-2816
Practice Address - Fax:910-521-3583
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06402363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1295180206Medicaid
1295180206OtherBCBS