Provider Demographics
NPI:1073792891
Name:LOCKWOOD, JESSICA KATHRYN (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:KATHRYN
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:KATHRYN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 E GENESEE ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1892
Mailing Address - Country:US
Mailing Address - Phone:315-471-8388
Mailing Address - Fax:315-471-8019
Practice Address - Street 1:1000 E GENESEE ST
Practice Address - Street 2:SUITE 500
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1892
Practice Address - Country:US
Practice Address - Phone:315-471-8388
Practice Address - Fax:315-471-8019
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012210363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant