Provider Demographics
NPI:1083202147
Name:GILLETTE, PATRICK GREY
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:GREY
Last Name:GILLETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13251 FALLS OF NEUSE RD
Mailing Address - Street 2:STE 121
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8573
Mailing Address - Country:US
Mailing Address - Phone:919-785-5055
Mailing Address - Fax:
Practice Address - Street 1:13251 FALLS OF NEUSE RD
Practice Address - Street 2:STE 121
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8573
Practice Address - Country:US
Practice Address - Phone:919-785-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11580363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant