Individual
JESSICA ELY PRUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3009 NEW BERN AVE, RALEIGH, NC 27610-1214
(919) 232-5020
(919) 232-5021
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-2266
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-12366
NC
363AS0400X
Surgical Physician Assistant
Primary
0010-12366
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871103382
—
NC
Enumeration date
08/10/2020
Last updated
04/28/2026
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