Basic Information
| Provider Information | |||||||||
| NPI: | 1194976381 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARD | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 BRENNER AVE | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281442515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047962164 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5641 POPLAR TENT RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280277533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047821955 | ||||||||
| FaxNumber: | 7047823903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2008 | ||||||||
| LastUpdateDate: | 01/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 012819 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 0010-02010 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1532PA | 05 | SC | MEDICAID | 1194976381 | 05 | NC | MEDICAID | 8102012 | 05 | NC | MEDICAID |