Provider Demographics
NPI:1427280650
Name:MENCEL, JOHANNA ELIZABETH HUGHES (PA-C)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ELIZABETH HUGHES
Last Name:MENCEL
Suffix:
Gender:F
Credentials:PA-C
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-3410
Mailing Address - Fax:704-512-6851
Practice Address - Street 1:7903 PROVIDENCE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-9763
Practice Address - Country:US
Practice Address - Phone:704-316-4460
Practice Address - Fax:704-316-4466
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04958363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2751PAMedicaid
NC1427280650Medicaid
NC0010-04958OtherNORTH CAROLINA MEDICAL LICENSE
NCNCL097FMedicare PIN
NCNCL097CMedicare PIN
NCNCL097BMedicare PIN
NC0010-04958OtherNORTH CAROLINA MEDICAL LICENSE
NC1427280650Medicaid