Individual
JESSICA GRAY BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4207 LAKE BOONE TRL STE 220, RALEIGH, NC 27607-6685
(919) 784-1410
Mailing address
4207 LAKE BOONE TRL STE 220, RALEIGH, NC 27607-6685
(919) 784-1410
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-01386
NC
Other
Enumeration date
09/29/2008
Last updated
05/22/2020
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