Basic Information
| Provider Information | |||||||||
| NPI: | 1487912176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAGG | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | ELIZABETH SHEARIN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3949 BROWNING PL | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276096536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197877411 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3949 BROWNING PL | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276096536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197877411 | ||||||||
| FaxNumber: | 9197894461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2012 | ||||||||
| LastUpdateDate: | 12/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 0010-03365 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | 0010-03365 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.