Provider Demographics
NPI:1285419846
Name:GARACH, GRACE REAGAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:REAGAN
Last Name:GARACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:GRACE
Other - Middle Name:IVES
Other - Last Name:REAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6300 CANARY FALLS LN APT 306
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-5855
Mailing Address - Country:US
Mailing Address - Phone:910-990-0908
Mailing Address - Fax:
Practice Address - Street 1:2605 BLUE RIDGE RD STE 225
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6459
Practice Address - Country:US
Practice Address - Phone:984-222-8000
Practice Address - Fax:984-222-8001
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13705363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant