Provider Demographics
NPI:1447589544
Name:FRAWLEY WOOLFOLK, JESSICA ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:FRAWLEY WOOLFOLK
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 1:327 N WASHINGTON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1535
Mailing Address - Country:US
Mailing Address - Phone:570-961-5522
Mailing Address - Fax:
Practice Address - Street 1:440 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704
Practice Address - Country:US
Practice Address - Phone:570-287-1122
Practice Address - Fax:570-207-5579
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054087363AM0700X
PAOA002400363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical