Provider Demographics
NPI:1154560449
Name:SCHENK, TIMOTHY RYAN (PA-C)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RYAN
Last Name:SCHENK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:SCHENK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:605 GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3233
Mailing Address - Country:US
Mailing Address - Phone:704-633-6442
Mailing Address - Fax:704-633-7569
Practice Address - Street 1:605 GROVE ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3233
Practice Address - Country:US
Practice Address - Phone:704-633-6442
Practice Address - Fax:704-633-7569
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01716363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical