Provider Demographics
NPI:1770067399
Name:BARBER, KATHLEEN ELISE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:ELISE
Last Name:BARBER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1951 OLD STEELE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-6080
Mailing Address - Country:US
Mailing Address - Phone:704-926-5434
Mailing Address - Fax:
Practice Address - Street 1:6005 HICKORY GROVE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-4129
Practice Address - Country:US
Practice Address - Phone:704-945-6480
Practice Address - Fax:704-945-6485
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08178363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-08178OtherNORTH CAROLINA MEDICAL BOARD