Provider Demographics
NPI:1346227105
Name:GRADY, JON BARKLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:BARKLEY
Last Name:GRADY
Suffix:
Gender:M
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 1:262 LEROY GEORGE DR
Mailing Address - Street 2:SUITE M
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-7430
Mailing Address - Country:US
Mailing Address - Phone:828-452-8378
Mailing Address - Fax:828-452-8326
Practice Address - Street 1:262 LEROY GEORGE DR
Practice Address - Street 2:SUITE M
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-7430
Practice Address - Country:US
Practice Address - Phone:828-452-8378
Practice Address - Fax:828-452-8326
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102852363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2752733AMedicare ID - Type Unspecified
NCP02966Medicare UPIN