Individual
BLAKE GRAYSON JOECKEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MMS, PA-C
Contact information
Practice address
116 COUNTRY CLUB DR, FAYETTEVILLE, NC 28301-7604
(910) 488-0157
Mailing address
3677 GLENBARRY CIR, FAYETTEVILLE, NC 28314-2605
(910) 273-5150
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0010-08813
NC
363A00000X
Physician Assistant
Primary
0010-08813
NC
Other
Enumeration date
01/30/2019
Last updated
05/22/2025
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