Provider Demographics
NPI:1467127902
Name:HENDERSON, JESSICA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:68 THOMAS JOHNSON DR STE C
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4901
Mailing Address - Country:US
Mailing Address - Phone:301-694-5292
Mailing Address - Fax:866-469-9533
Practice Address - Street 1:68 THOMAS JOHNSON DR STE C
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4901
Practice Address - Country:US
Practice Address - Phone:301-694-5292
Practice Address - Fax:866-469-9533
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2022-10-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant