Provider Demographics
NPI:1497270490
Name:GASKE, JESSICA J (PNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:J
Last Name:GASKE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENEVUS
Mailing Address - State:NY
Mailing Address - Zip Code:12155-3909
Mailing Address - Country:US
Mailing Address - Phone:607-638-6007
Mailing Address - Fax:
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1301
Practice Address - Country:US
Practice Address - Phone:607-547-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382777363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics