Provider Demographics
NPI:1114475605
Name:JOPP, GRETCHEN DIANE (PA-C)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:DIANE
Last Name:JOPP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:DIANE
Other - Last Name:HUHNERKOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-638-8631
Mailing Address - Fax:704-638-8639
Practice Address - Street 1:1910 JAKE ALEXANDER BLVD W STE 201
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147
Practice Address - Country:US
Practice Address - Phone:704-638-8631
Practice Address - Fax:704-638-8639
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363AS0400X
NC0010-06783363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical