Provider Demographics
NPI:1619390424
Name:ROELKEY, JESSICA (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ROELKEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20311 LAPPANS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-2086
Mailing Address - Country:US
Mailing Address - Phone:301-799-1098
Mailing Address - Fax:301-799-1367
Practice Address - Street 1:20311 LAPPANS RD STE 100
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-2086
Practice Address - Country:US
Practice Address - Phone:301-799-1098
Practice Address - Fax:301-799-1367
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01785363A00000X
MDC005594363A00000X
VA0110007990363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant