Provider Demographics
NPI:1386948974
Name:FRENTZEL, ADRIENNE KING (PA)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:KING
Last Name:FRENTZEL
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1090 NE GATEWAY CT NE
Practice Address - Street 2:STE 202
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2414
Practice Address - Country:US
Practice Address - Phone:704-403-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03494363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1386948974Medicaid
SC1359PAMedicaid
NC8102137Medicaid
NCNC6611LMedicare PIN
NC1386948974Medicaid
NCNC6611JMedicare PIN
NCNC6611NMedicare PIN
NCNC6611EMedicare PIN
NCNC6611MMedicare PIN
NCNC6611OMedicare PIN
NCNC6611CMedicare PIN
NCNC6611BMedicare PIN
NCNC6611AMedicare PIN
NC8102137Medicaid
NCNC6611KMedicare PIN
SC1359PAMedicaid
NCNC6611IMedicare PIN
NCNC6611GMedicare PIN