Provider Demographics
NPI:1538107388
Name:CRANE, JESSICA BLYTHE (PA)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:BLYTHE
Last Name:CRANE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL- CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-926-6992
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:35 GILBERT STREET
Practice Address - Street 2:CAMBRIDGE MEDICAL CENTER
Practice Address - City:CAMBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12816
Practice Address - Country:US
Practice Address - Phone:518-677-3163
Practice Address - Fax:518-677-3180
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2024-02-28
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Provider Licenses
StateLicense IDTaxonomies
NY011068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400053020Medicare PIN
NYJ400053021Medicare PIN