Provider Demographics
NPI:1366015448
Name:PHAM, THAO KIM (PA-C)
Entity type:Individual
Prefix:MISS
First Name:THAO
Middle Name:KIM
Last Name:PHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:ENGELHARD
Mailing Address - State:NC
Mailing Address - Zip Code:27824-0277
Mailing Address - Country:US
Mailing Address - Phone:252-925-7000
Mailing Address - Fax:252-925-7700
Practice Address - Street 1:33270 US HIGHWAY 264
Practice Address - Street 2:
Practice Address - City:ENGELHARD
Practice Address - State:NC
Practice Address - Zip Code:27824-9557
Practice Address - Country:US
Practice Address - Phone:252-925-7000
Practice Address - Fax:252-925-7700
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11951363AM0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical