Provider Demographics
NPI:1073789798
Name:GRAY, ERIN JENSEN (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JENSEN
Last Name:GRAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 HORSE PEN CREEK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9700
Mailing Address - Country:US
Mailing Address - Phone:336-617-6568
Mailing Address - Fax:336-617-6660
Practice Address - Street 1:2835 HORSE PEN CREEK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410
Practice Address - Country:US
Practice Address - Phone:336-617-6568
Practice Address - Fax:336-617-6660
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00310363AM0700X
NC1068918363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical