Provider Demographics
NPI:1093321846
Name:BROOKSHIRE, JESSICA RAE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:BROOKSHIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HENDERSONVILLE HWY
Mailing Address - Street 2:STE A
Mailing Address - City:PISGAH FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:28768-8895
Mailing Address - Country:US
Mailing Address - Phone:828-435-8100
Mailing Address - Fax:828-435-8401
Practice Address - Street 1:45 HENDERSONVILLE HWY
Practice Address - Street 2:
Practice Address - City:PISGAH FOREST
Practice Address - State:NC
Practice Address - Zip Code:28768-9296
Practice Address - Country:US
Practice Address - Phone:828-435-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC0010-10891363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty