Provider Demographics
NPI:1235598210
Name:ALEX, JESSLY (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSLY
Middle Name:
Last Name:ALEX
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 PHEASANT DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3036
Mailing Address - Country:US
Mailing Address - Phone:215-450-1032
Mailing Address - Fax:
Practice Address - Street 1:930 HENRIETTA AVE STE C
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-8523
Practice Address - Country:US
Practice Address - Phone:215-663-9380
Practice Address - Fax:215-663-9383
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPO15926363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology