Basic Information
| Provider Information | |||||||||
| NPI: | 1801814124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PADGETT | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | KATRINA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11491 US HIGHWAY 70 W | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275202207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195502484 | ||||||||
| FaxNumber: | 9195507059 | ||||||||
| Practice Location | |||||||||
| Address1: | 11491 US HIGHWAY 70 W | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275202207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195502484 | ||||||||
| FaxNumber: | 9195507059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 102873 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.