Provider Demographics
NPI:1376975086
Name:PYKOSZ, JESSICA (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PYKOSZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6939 COX RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7595
Mailing Address - Country:US
Mailing Address - Phone:513-791-5200
Mailing Address - Fax:513-791-5229
Practice Address - Street 1:6939 COX RD
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45069-7595
Practice Address - Country:US
Practice Address - Phone:513-791-5200
Practice Address - Fax:513-791-5229
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004800RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant