Healthcare Provider Details

I. General information

NPI: 1174903538
Provider Name (Legal Business Name): STEPHANIE CHRISTEN PRITCHETT PETERSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE CHRISTIAN PRITCHETT

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 N CHURCH ST
GREENSBORO NC
27401-1007
US

IV. Provider business mailing address

815 CALICO CREEK DR
GARNER NC
27529-5958
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-4400
  • Fax: 336-832-4440
Mailing address:
  • Phone: 770-906-4556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-05765
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-05765
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: