Provider Demographics
NPI:1205066453
Name:DUVERNOIS, DAVID ALAN WINSTON (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN WINSTON
Last Name:DUVERNOIS
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:PO BOX 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-355-8686
Mailing Address - Fax:704-355-8687
Practice Address - Street 1:1023 EDGEHILL RD S
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1829
Practice Address - Country:US
Practice Address - Phone:704-355-8686
Practice Address - Fax:704-355-8687
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003334363A00000X
NC0010-01907363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205066453Medicaid
SC1560PAMedicaid
NC8103037Medicaid
NC1205066453Medicaid