Provider Demographics
NPI:1043612468
Name:O'KEEFE, JESSICA L (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:DESTEFANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:19847 CENTURY BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-7204
Mailing Address - Country:US
Mailing Address - Phone:240-912-2206
Mailing Address - Fax:240-912-2381
Practice Address - Street 1:19847 CENTURY BLVD STE 205
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-7204
Practice Address - Country:US
Practice Address - Phone:240-912-2206
Practice Address - Fax:240-912-2381
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant