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

Mr. Derek Kelly Coburn, PA

Individual provider Emergency Medicine Physician · NPI 1861851784

Mr. Derek Kelly Coburn, PA is a Physician Assistant in Charlotte, North Carolina. Qualified in 2015, 11 years ago. Practices with Carolinas Physicians Network Inc, a 2,328-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
11
Licensed in
NC
In the registry since
2016
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

2001 Vail Ave
Charlotte, NC 28207-1248
Phone: (208) 863-8974
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 14214 Ballantyne Lake Rd Ste 100, Charlotte, NC 28277-3373 — (704) 667-2650

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-06199 (NC)
Emergency Medicine Physician Taxonomy 207P00000X · Licence 001006199 (NC)

Record details

NPI number1861851784
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedFebruary 19, 2016
Last updated in NPPESJune 10, 2020
Certification dateJune 10, 2020

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Carolinas Physicians Network Inc — 2328 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations14 on file with Medicare

Other providers in Charlotte