Provider Demographics
NPI:1083018972
Name:LEIGH, JESSICA LYNN (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:LEIGH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2209 GENESEE STREET
Mailing Address - Street 2:BUSINESS OFFICE ROOM 310
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5930
Mailing Address - Country:US
Mailing Address - Phone:315-801-3282
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:6 HAMPDEN PL
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5631
Practice Address - Country:US
Practice Address - Phone:315-733-2526
Practice Address - Fax:315-733-2846
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2018-11-05
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Provider Licenses
StateLicense IDTaxonomies
NY018180363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04068764Medicaid