Provider Demographics
NPI:1033699731
Name:BACA, JESSICA FRANCES (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FRANCES
Last Name:BACA
Suffix:
Gender:F
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 1:885 MISSION ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-6222
Mailing Address - Country:US
Mailing Address - Phone:503-814-0273
Mailing Address - Fax:
Practice Address - Street 1:885 MISSION ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-6222
Practice Address - Country:US
Practice Address - Phone:503-814-0273
Practice Address - Fax:503-814-0273
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA204321363A00000X
NMPA2018-0057363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant