Provider Demographics
NPI:1760260681
Name:DRUMMOND, MONNIE JORDAN (PA-C)
Entity Type:Individual
Prefix:
First Name:MONNIE
Middle Name:JORDAN
Last Name:DRUMMOND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MONNIE
Other - Middle Name:JORDAN
Other - Last Name:DAVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 GATEWAY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6542
Mailing Address - Country:US
Mailing Address - Phone:704-230-1302
Mailing Address - Fax:704-230-1284
Practice Address - Street 1:118 GATEWAY BLVD STE A
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6542
Practice Address - Country:US
Practice Address - Phone:704-230-1302
Practice Address - Fax:704-230-1284
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13735363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant