NPIMap

Individual provider Active NPI

Michele T Provost, PA

  • Physician Assistant
  • Fayetteville, NC
National Provider Identifier
1043388754
Registry record updated Mar 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-02284 Issued in NC
Practice address
2125 Valleygate Dr Ste 201
Fayetteville, NC 28304-3754
Phone
(910) 920-1450
Fax
(910) 920-1450
NPI assigned
Dec 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-02284 NC Primary

Addresses

Primary practice location

2125 Valleygate Dr Ste 201
Fayetteville, NC 28304-3754

Mailing address

2125 Valleygate Dr Ste 201
Fayetteville, NC 28304-3754
Phone (910) 920-1450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190122003216 NC Practitioner - Physician Assistant 4486753308 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolina Rheumatology and Internal Medicine PAGroup PAC ID 6608921242, 4 clinicians

Practice addresses (Care Compare)

2125 Valleygate Dr
Suite 201
Fayetteville, NC 28304-3754
Phone (910) 920-1450

Hospital & facility affiliations

  • Cape Fear Valley Medical Center Hospital, Fayetteville, NC, CCN 340028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Anthony Cicoria, MD, PLLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: michele.provost.p24@direct.aara1.nextgenshare.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/JIGIDD/Endpoint/JIGIDD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741046400000",
    "number": "1043388754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 VALLEYGATE DR STE 201",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043754",
            "telephone_number": "910-920-1450",
            "fax_number": "910-920-1864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 VALLEYGATE DR STE 201",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043754",
            "telephone_number": "910-920-1450",
            "fax_number": "910-920-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVOST",
        "first_name": "MICHELE",
        "middle_name": "T",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-02284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.