Provider Demographics
NPI:1780024018
Name:DIEHL, JASON ANDREW (PA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ANDREW
Last Name:DIEHL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:704-316-5388
Mailing Address - Fax:704-316-1848
Practice Address - Street 1:16525 HOLLY CREST LN
Practice Address - Street 2:SUITE 120
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4909
Practice Address - Country:US
Practice Address - Phone:704-316-5388
Practice Address - Fax:704-316-1848
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001004349363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant