Provider Demographics
NPI:1467659706
Name:RUPERT, JAMIE L (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:L
Last Name:RUPERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:PAULITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1144 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6734
Mailing Address - Country:US
Mailing Address - Phone:215-351-5560
Mailing Address - Fax:267-536-4191
Practice Address - Street 1:1144 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6734
Practice Address - Country:US
Practice Address - Phone:215-351-5560
Practice Address - Fax:267-536-4191
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2022-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052812363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical