JESSICA GRAY BROCK (NPI# 1699925537) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699925537 |
| Entity Type | Individual |
| Full Name | JESSICA GRAY BROCK |
| Other Name | JESSICA GRAY EATON |
| Credential | PA-C |
| Practice Address |
4207 Lake Boone Trl Ste 220 Raleigh NC 27607-6685 |
| Practice Telephone | 9197841410 |
| Mailing Telephone | 9197841410 |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2020-05-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 0010-01386 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356909360 | Jessica Beth Brock | Early Intervention Provider Agency | 42 Gwendolyn Pl, East Islip, NY 11730-3220 | 2019-06-04 |
| 1902125024 | Jessica C Brock | Physician Assistant | Endocrinology Clinic, 740 S. Limestone, Lexington, KY 40536-0284 | 2010-05-28 |
| 1962636233 | Jessica M Brock | Radiologic Technologist | 169 Highland Dr, Mandeville, LA 70471 | 2009-05-14 |
| 1376157578 | Jessica Shae Brock | Technician | 87 Swierkos Dr, Moundsville, WV 26041-4209 | 2020-09-04 |
| 1851846802 | Jessica Suzanne Brock | Specialist/Technologist | 180 Hansen Ct, Wood Dale, IL 60191-1121 | 2016-08-19 |
| 1891191102 | Jessica Brock | Physical Therapist | 125 Dillmont Dr, Columbus, OH 43235-4658 | 2014-11-13 |
| 1295148914 | Jessica Marie Brock | Nurse Practitioner | 1010 Main St S, Mc Kee, KY 40447-7089 | 2014-06-10 |
| 1740582915 | Jessica Brock | Licensed Practical Nurse | 1680 Walden Ave, Cheektowaga, NY 14225-4914 | 2010-11-22 |
| 1053540450 | Jessica Nicole Brock | Nurse Practitioner | 5955 Airport Blvd, Mobile, AL 36608 | 2009-07-07 |
| Street Address |
4207 LAKE BOONE TRL STE 220 |
| City | RALEIGH |
| State | NC |
| Zip Code | 27607-6685 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932174372 | Robin Frederick Koeleveld | Neurological Surgery | 4207 Lake Boone Trl Ste 220, Raleigh, NC 27607-6685 | 2006-02-21 |
| 1922573823 | Allyssa Blaire Newton | Nurse Practitioner | 4207 Lake Boone Trl Ste 220, Raleigh, NC 27607-6685 | 2018-10-06 |
| 1750587036 | John A Engler | Neurological Surgery | 4207 Lake Boone Trl Ste 220, Raleigh, NC 27607-6685 | 2007-06-25 |
| 1073588000 | Samuel K St Clair | Neurological Surgery | 4207 Lake Boone Trl Ste 220, Raleigh, NC 27607-6685 | 2006-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972093144 | Kyndra Lawson | Behavior Technician | 5121 Kingdom Way, Suite 100, Raleigh, NC 27607 | 2018-05-14 |
| 1578082905 | Margaret Roberts Bova | Dietitian, Registered | 4207 Lake Boone Trail, Suite 210, Raleigh, NC 27607 | 2017-09-18 |
| 1184141897 | Chricat Garrard | Nurse Practitioner | 4207 Lake Boone Trl Ste 200, Raleigh, NC 27607 | 2017-08-23 |
| 1487178620 | John Patrick Morton | Pharmacist | 2411 Landmark Dr, Raleigh, NC 27607 | 2017-07-31 |
| 1023538857 | Heather Margaret Mazzola | Audiologist | 7800 Lake Boone Trail, 100, Raleigh, NC 27607 | 2017-06-22 |
| 1790216984 | North Carolina Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 2411 Landmark Drive, Raleigh, NC 27607 | 2017-03-21 |
| 1558819516 | Corilin Nocito Meggitt | Nurse Practitioner | 4505 Fair Meadows Ln Ste 102, Raleigh, NC 27607 | 2016-09-19 |
| 1942757034 | Stacie Walker | Obstetrics & Gynecology | 4414 Lake Boone Trl Ste 311, Raleigh, NC 27607 | 2016-09-06 |
| 1831644533 | Alisa Smajlagic Howe | Nurse Practitioner | 4210 Lake Boone Trail, Rex Rehab & Nursing Center, Raleigh, NC 27607 | 2016-08-23 |
| 1235598632 | Yoseph Saleh | Dentist | 107 Minden Ln, Raleigh, NC 27607 | 2016-02-15 |
| Find all providers in zip 27607 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457961682 | Megan Kathleen Brown | Physician Assistant | 3024 New Bern Ave Ste 102, Raleigh, NC 27610-1247 | 2020-08-03 |
| 1124640651 | Kayla Marie Sincock | Physician Assistant | 12205 Harcourt Dr, Raleigh, NC 27613-5603 | 2020-05-06 |
| 1093340531 | Hannah Stanifer | Physician Assistant | 510 N Wilmington St Apt 227, Raleigh, NC 27604-8021 | 2020-03-05 |
| 1962035642 | Brianna Stolz | Physician Assistant | 3811 Ed Dr Ste 110, Raleigh, NC 27612-2393 | 2020-02-20 |
| 1316577737 | Jacey Elizabeth Byers | Physician Assistant | 700 Hawes Ct Apt C, Raleigh, NC 27608-1745 | 2020-01-24 |
| 1033756598 | Julie A Romeis | Physician Assistant | 1929 N Hills Dr Unit G, Raleigh, NC 27612-4022 | 2019-12-04 |
| 1346886769 | Pooja Parmar | Physician Assistant | 8804 Bluff Pointe Ct, Raleigh, NC 27615-4172 | 2019-11-20 |
| 1649829557 | Bryan Edwards | Physician Assistant | 4551 New Bern Ave Ste A100, Raleigh, NC 27610-1551 | 2019-09-04 |
| 1790343192 | Savanah Palen Mullen | Physician Assistant | 10208 Cerny St Ste 204, Raleigh, NC 27617-7885 | 2019-05-31 |
| 1356906184 | Andrew Paul Apicella | Physician Assistant | 3024 New Bern Ave Ste 302, Raleigh, NC 27610-1247 | 2019-05-07 |
| Find all providers in RALEIGH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.