Provider Demographics
NPI:1073182879
Name:HATFIELD, JESSICA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:5133 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6338
Practice Address - Country:US
Practice Address - Phone:843-789-1800
Practice Address - Fax:843-606-8036
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2022-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601010465363A00000X
SC4554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant