Provider Demographics
NPI:1366050791
Name:CECKA, RACHAEL JAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:JAN
Last Name:CECKA
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 1:2711 RANDOLPH RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2027
Mailing Address - Country:US
Mailing Address - Phone:704-334-0600
Mailing Address - Fax:704-334-0615
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:SUITE 305
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2027
Practice Address - Country:US
Practice Address - Phone:704-334-0600
Practice Address - Fax:704-334-0615
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC001011524363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program