Provider Demographics
NPI:1669459459
Name:KERCHNER, AIMEE BUCK (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:BUCK
Last Name:KERCHNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AIMEE
Other - Middle Name:OLIVIA
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-5420
Mailing Address - Fax:704-384-5424
Practice Address - Street 1:1901 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1101
Practice Address - Country:US
Practice Address - Phone:704-384-5420
Practice Address - Fax:704-384-5424
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102969363AM0700X
NC0010-00303363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC946356654QMedicaid
NC946356654QMedicaid
NCQ62427Medicare UPIN