Basic Information
| Provider Information | |||||||||
| NPI: | 1093321846 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOKSHIRE | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | RAE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 HENDERSONVILLE HWY | ||||||||
| Address2: | STE A | ||||||||
| City: | PISGAH FOREST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287688895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284358100 | ||||||||
| FaxNumber: | 8284358401 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 HENDERSONVILLE HWY | ||||||||
| Address2: | |||||||||
| City: | PISGAH FOREST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287689296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284358100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2020 | ||||||||
| LastUpdateDate: | 06/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363A00000X | 0010-10891 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.