Provider Demographics
NPI:1356763072
Name:TAYLOR, JESSICA GRAY (PA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:GRAY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX K
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27533-9710
Mailing Address - Country:US
Mailing Address - Phone:919-731-6060
Mailing Address - Fax:919-587-2988
Practice Address - Street 1:2700 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9494
Practice Address - Country:US
Practice Address - Phone:919-731-6060
Practice Address - Fax:919-587-2988
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC001004695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1004695OtherNC MEDICAL BOARD
MT3103025OtherDEA