MS. JESSICA FOWLER MICHALAK (NPI# 1588060412) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588060412 |
| Entity Type | Individual |
| Full Name | MS. JESSICA FOWLER MICHALAK |
| Credential | PA-C |
| Practice Address |
2104 Randolph Rd Charlotte NC 28207-1522 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 7043773900 |
| Practice Fax Number | 7043771244 |
| Mailing Telephone | 7045344290 |
| Mailing Fax Number | 7043771244 |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2020-10-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
0010-05219 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679093470 | Jessica Leah Michalak | Nurse Practitioner | 200 1st St Sw, Rochester, MN 55905-0001 | 2017-06-22 |
| Street Address |
2104 RANDOLPH RD |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28207-1522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710999628 | Ilan D Avin | Surgery | 2104 Randolph Rd, Charlotte, NC 28207 | 2006-08-12 |
| 1356852446 | Michael Andrianos Thomopoulos | Physician Assistant | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2017-10-17 |
| 1578072989 | Carter Martens | Surgery | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2017-09-28 |
| 1588185094 | Victoria Levesque | Dietitian, Registered | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2017-07-06 |
| 1821525239 | Novant Medical Group, Inc. | Surgery | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2017-05-16 |
| 1346607827 | Lauren Taylor Sandberg | Physician Assistant | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2016-01-28 |
| 1952776825 | Sarah Klecha Ingold | Physician Assistant | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2015-12-03 |
| 1851612089 | Nicholas Latchana | Surgery | 2104 Randolph Rd, Charlotte, NC 28207 | 2010-06-22 |
| 1245338557 | Carolina Surgical Clinic of Charlotte, Pa | Surgery | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2006-09-20 |
| 1417055716 | Carl Jarrett Lowe Jr. | Surgery | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2006-09-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013560739 | Louis Roncaglione | Dentist | 8815 Christenbury Pkway, Concord, NC 28207 | 2019-07-22 |
| 1619430014 | Khrystyna Levytska | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Ob/gyn, 1350 S. Kings Dr., Charlotte, NC 28207 | 2019-04-11 |
| 1649743584 | Carolinas Hometown Respiratory LLC | Durable Medical Equipment & Medical Supplies | 1005 South Kings Drive, Charlotte, NC 28207 | 2019-01-03 |
| 1023584489 | Herron and Smith Associates, Pllc | Dentist | 135 Perrin Place, Suite 100, Charlotte, NC 28207 | 2018-10-23 |
| 1588161640 | Lauren Mogk | Student in an Organized Health Care Education/Training Program | Myers Park Clinical Internal Medicine, 1350 S. Kings Dr., 3rd Floor, Charlotte, NC 28207 | 2018-04-06 |
| 1518462241 | Sarah Hollyn Carlock | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Internal Medicine, 1350 S Kings Dr, 3rd Floor, Charlotte, NC 28207 | 2018-03-26 |
| 1083118178 | Claire Milam | Student in an Organized Health Care Education/Training Program | Cmc/department of Emergency Medicine, 100 Blythe Blvd, Charlotte, NC 28207 | 2018-03-22 |
| 1811422256 | Complete Care At Dartmouth LLC | Skilled Nursing Facility | 300 Province Road, Charlotte, NC 28207 | 2017-04-24 |
| 1063945467 | Kaitlyn O'keefe | Internal Medicine | 1350 S. Kings Dr., 3rd Floor, Myers Park Clinic Internal Medicine, Charlotte, NC 28207 | 2017-04-04 |
| 1811432024 | Advanced Prosthetics of Easley, Inc | Durable Medical Equipment & Medical Supplies | 2310 Randolph Rd Ste A, Charlotte, NC 28207 | 2016-12-23 |
| Find all providers in zip 28207 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316411713 | Nicole Alyse Zbiciak | Physician Assistant | 325 Hawthorne Ln Ste 300, Charlotte, NC 28204-2536 | 2019-01-18 |
| 1396154209 | Kayla Lacci | Physician Assistant | 1025 Morehead Medical Dr, Ste 300, Charlotte, NC 28204-2963 | 2014-08-05 |
| 1457794125 | Lauren S Jones | Physician Assistant | 225 Baldwin Ave, Charlotte, NC 28204-3109 | 2013-04-12 |
| 1073879060 | Michael A Marconi | Physician Assistant | 3541 Randolph Road, Suite 210, Charlotte, NC 28211-2886 | 2012-04-04 |
| 1912284266 | Sapnil D Patel | Physician Assistant | 225 Baldwin Ave, Charlotte, NC 28204-3109 | 2011-11-14 |
| 1215222310 | Angela Marie Darket | Physician Assistant | 225 Baldwin Ave, Charlotte, NC 28204-3109 | 2011-06-16 |
| 1164730487 | Kristin Kathleen Teague | Physician Assistant | 200 Hawthorne Ln, Charlotte, NC 28204-2515 | 2010-09-21 |
| 1700110814 | Rachelle M. Eiden | Physician Assistant | 10512 Park Rd, Suite 101, Charlotte, NC 28210-8475 | 2009-09-22 |
| 1588849327 | Orthocarolina | Physician Assistant | 4601 Park Rd, Suite 300, Charlotte, NC 28209-3239 | 2007-12-28 |
| 1649394412 | Katherine Graham Fernandez | Physician Assistant | 15825 Ballantyne Medical Pl, Suite 240, Charlotte, NC 28277-4652 | 2007-03-19 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.