Provider Demographics
NPI:1407398548
Name:FLANIGAN, JESSICA LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:FLANIGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:GREENWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7500 BROOKTREE RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9254
Mailing Address - Country:US
Mailing Address - Phone:412-367-0600
Mailing Address - Fax:412-367-7079
Practice Address - Street 1:354 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2402
Practice Address - Country:US
Practice Address - Phone:704-786-5122
Practice Address - Fax:704-782-8279
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058750363AS0400X
NC0010-13723363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical