Individual
ENGLISH B BLACK I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
4010 MENDENHALL OAKS PKWY, HIGH POINT, NC 27265-8076
(336) 887-3195
(336) 887-3194
Mailing address
4010 MENDENHALL OAKS PKWY, HIGH POINT, NC 27265-8076
(336) 887-3195
(336) 887-3194
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0001-04013
NC
363AM0700X
Medical Physician Assistant
PA19680
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2760634
MEDICARE ID
NC
Enumeration date
05/10/2006
Last updated
05/10/2021
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