Provider Demographics
NPI:1770795098
Name:SIMONS, GRETCHEN WHITE (PNP)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:WHITE
Last Name:SIMONS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 BENTHALL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27855-9532
Mailing Address - Country:US
Mailing Address - Phone:252-396-0564
Mailing Address - Fax:
Practice Address - Street 1:700 SUNSET AVE E
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3547
Practice Address - Country:US
Practice Address - Phone:252-332-3403
Practice Address - Fax:252-332-1655
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200714363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics