Provider Demographics
NPI:1194976381
Name:CARD, KATHERINE M (PA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:CARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 BRENNER AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2515
Mailing Address - Country:US
Mailing Address - Phone:704-796-2164
Mailing Address - Fax:
Practice Address - Street 1:5641 POPLAR TENT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7533
Practice Address - Country:US
Practice Address - Phone:704-782-1955
Practice Address - Fax:704-782-3903
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012819363AM0700X
NC0010-02010363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1532PAMedicaid
NC1194976381Medicaid
NC8102012Medicaid
NCNC0193AMedicare PIN
NC8102012Medicaid
SC1532PAMedicaid
NCNC0193CMedicare PIN