Provider Demographics
NPI:1043215411
Name:JOURNIGAN, GRETCHEN BLAIR (PA-C)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:BLAIR
Last Name:JOURNIGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 STANTONSBURG RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2868
Mailing Address - Country:US
Mailing Address - Phone:252-413-0036
Mailing Address - Fax:252-413-0038
Practice Address - Street 1:2245 STANTONSBURG RD
Practice Address - Street 2:SUITE H
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2868
Practice Address - Country:US
Practice Address - Phone:252-413-0036
Practice Address - Fax:252-413-0038
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103051363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2754923BMedicare ID - Type Unspecified
NCP53119Medicare UPIN