Provider Demographics
NPI:1639350952
Name:HURLEY, JESSICA ANNETTE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANNETTE
Last Name:HURLEY
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 1:700 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-1465
Mailing Address - Country:US
Mailing Address - Phone:937-783-2600
Mailing Address - Fax:937-783-3086
Practice Address - Street 1:700 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107-1465
Practice Address - Country:US
Practice Address - Phone:937-783-2600
Practice Address - Fax:937-783-3086
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002164363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant