Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kevin Wayne Greene, PA

Individual provider Physician Assistant · NPI 1265476675

Kevin Wayne Greene, PA is a Physician Assistant in Charlotte, North Carolina. Qualified in 2005, 21 years ago. Practices with Mecklenburg Radiology Associates PA, a 94-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
21
Licensed in
NC
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

3623 Latrobe Dr Ste 216
Charlotte, NC 28211-2117
Phone: (704) 332-1291
Fax: (704) 332-5206
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-00420 (NC)

Record details

NPI number1265476675
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJune 15, 2006
Last updated in NPPESFebruary 3, 2023
Certification dateOctober 1, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice Mecklenburg Radiology Associates Pa — 94 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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