Provider Demographics
NPI:1467187187
Name:HATHAWAY, JESSAMY (PA)
Entity Type:Individual
Prefix:
First Name:JESSAMY
Middle Name:
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903-0727
Mailing Address - Country:US
Mailing Address - Phone:207-824-2193
Mailing Address - Fax:
Practice Address - Street 1:32 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:ME
Practice Address - Zip Code:04217-3819
Practice Address - Country:US
Practice Address - Phone:207-824-2193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant