Provider Demographics
NPI:1902808033
Name:WETMORE, DONALD K (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:K
Last Name:WETMORE
Suffix:
Gender:M
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 1:50 HOSPITAL DR
Mailing Address - Street 2:STE 3B
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-5245
Mailing Address - Country:US
Mailing Address - Phone:828-684-2234
Mailing Address - Fax:828-684-6693
Practice Address - Street 1:50 HOSPITAL DR
Practice Address - Street 2:STE 3B
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5245
Practice Address - Country:US
Practice Address - Phone:828-684-2234
Practice Address - Fax:828-684-6693
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100301363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC582333928OtherTAX ID USED BY INS COS
SCNPA709Medicaid
NC0227UOtherBCBS NC GROUP ID #
NC12664OtherBCBS NC INDIVIDUAL ID
NC8912664Medicaid
NC890227UMedicaid
NC2746140Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID #
NC890227UMedicaid
NC2323402Medicare ID - Type UnspecifiedMEDICARE GROUP ID #