Provider Demographics
NPI:1518375591
Name:METZGER, JESSICA BROOKE (PA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BROOKE
Last Name:METZGER
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 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-757-0434
Mailing Address - Fax:859-441-0906
Practice Address - Street 1:2626 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1530
Practice Address - Country:US
Practice Address - Phone:859-757-0434
Practice Address - Fax:859-441-0906
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001710A363A00000X
IN99062936A363A00000X
KYPA2095363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN99062936AOtherLICENSE
KYP01636966OtherRAILROAD MEDICARE
KY7100408710Medicaid
OH0162019Medicaid
OH0162019Medicaid