Provider Demographics
NPI:1902199789
Name:HOPKINS, SUSAN LEE (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 WILL ISAACS RD
Mailing Address - Street 2:
Mailing Address - City:ZIONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28698-9051
Mailing Address - Country:US
Mailing Address - Phone:336-469-9850
Mailing Address - Fax:
Practice Address - Street 1:870 STATE FARM RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4861
Practice Address - Country:US
Practice Address - Phone:828-264-0029
Practice Address - Fax:828-265-3305
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical