Provider Demographics
NPI:1396923322
Name:KENDALL, EMILY (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KENDALL
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 1:11301 CARMEL COMMONS BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5305
Mailing Address - Country:US
Mailing Address - Phone:704-372-7974
Mailing Address - Fax:704-970-4746
Practice Address - Street 1:8210 UNIVERSITY EXEC PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1329
Practice Address - Country:US
Practice Address - Phone:704-547-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01229363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396923322Medicaid
NC8101246Medicaid
NC8101246Medicaid
NCNC2778FMedicare PIN
NCNC2778DMedicare PIN
NCNC2778CMedicare PIN
NCNC2778GMedicare PIN
NCNC2778HMedicare PIN
NCNC2778IMedicare PIN
NCNC2778BMedicare PIN
NCNC2778AMedicare PIN
NCNC2778MMedicare PIN
NCNC2778KMedicare PIN
NC1396923322Medicaid
NCNC2778LMedicare PIN