Provider Demographics
NPI:1063567626
Name:TEETER, KACIE MILLER (PA-C)
Entity type:Individual
Prefix:MS
First Name:KACIE
Middle Name:MILLER
Last Name:TEETER
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 896199 STATESVILLE FAMILY PRACTICE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-5319
Mailing Address - Country:US
Mailing Address - Phone:833-936-1364
Mailing Address - Fax:605-942-7505
Practice Address - Street 1:310 DAVIE AVE
Practice Address - Street 2:STATESVILLE FAMILY PRACTICE
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5319
Practice Address - Country:US
Practice Address - Phone:704-873-3269
Practice Address - Fax:704-871-8159
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2021-03-09
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Provider Licenses
StateLicense IDTaxonomies
NC001000789363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical