Provider Demographics
NPI:1427335157
Name:GRAVEL, GRETCHEN ARLENE (ARNP-BC)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:ARLENE
Last Name:GRAVEL
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:MISS
Other - First Name:GRETCHEN
Other - Middle Name:ARLENE
Other - Last Name:WEINSPACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:131 SUMMERPLACE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3058
Mailing Address - Country:US
Mailing Address - Phone:803-794-4585
Mailing Address - Fax:
Practice Address - Street 1:131 SUMMERPLACE DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3058
Practice Address - Country:US
Practice Address - Phone:803-794-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17611363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC57-0713425Medicaid