Active NPI
Mary Deakle, PA-C
- Physician Assistant
- Clemmons, NC
National Provider Identifier
1992762538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 100874
- Practice address
- 6301 Stadium Dr
Clemmons, NC 27012-8766 - Phone
- (336) 766-6473
- Fax
- (336) 766-8909
- NPI assigned
- Apr 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 100874 | NC | |
| Physician Assistant | 363A00000X | 100874 | NC | Primary |
Addresses
Primary practice location
6301 Stadium Dr
Clemmons, NC 27012-8766
Mailing address
PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 766-6473
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00654536 | Other | NC | RAILROAD MEDICARE |
| 8101680 | Medicaid | NC |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mdeakle4872@direct.novanthealth.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603843200000",
"number": "1992762538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 751803",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282751803",
"telephone_number": "336-766-6473",
"fax_number": "336-766-8909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6301 STADIUM DR",
"city": "CLEMMONS",
"state": "NC",
"postal_code": "270128766",
"telephone_number": "336-766-6473",
"fax_number": "336-766-8909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEAKLE",
"first_name": "MARY",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-27",
"last_updated": "2020-10-28",
"certification_date": "2020-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NC",
"license": "100874",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "100874",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00654536",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8101680",
"state": "NC"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mdeakle4872@direct.novanthealth.org",
"affiliation": "N",
"address_1": "6301 Stadium Dr",
"city": "Clemmons",
"state": "NC",
"country_code": "US",
"postal_code": "270128766",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Clemmons, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.