Basic Information
| Provider Information | |||||||||
| NPI: | 1235159260 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRANT | ||||||||
| FirstName: | GRETCHEN | ||||||||
| MiddleName: | JANINIA | ||||||||
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| Credential: | M.S.P.A-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 724 AUBREY BELL DRIVE | ||||||||
| Address2: | |||||||||
| City: | MATTHEWS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281055055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953550 | ||||||||
| FaxNumber: | 7042953556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 01/31/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0010-03037 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | MA051978 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1679J | 01 | NC | BCBSNC | OTHER | 8102326 | 05 | NC | MEDICAID | 1298PA | 05 | SC | MEDICAID | 9965514 | 01 | AETNA | OTHER | P01103054 | 01 | NC | RAILROAD MEDICARE | OTHER |