Individual
CARLY MOOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3 RIVERSIDE CIR, ROANOKE, VA 24016-4955
(540) 224-5170
(540) 983-8212
Mailing address
213 S JEFFERSON ST STE 625, ROANOKE, VA 24011-1713
(540) 224-5516
(540) 224-5684
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110006713
VA
363A00000X
Physician Assistant
—
VA
Other
Enumeration date
05/03/2019
Last updated
01/28/2021
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