Provider Demographics
NPI:1639717747
Name:BURT, JESSICA CAROLANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CAROLANN
Last Name:BURT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:CAROLANN
Other - Last Name:SINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 DOUGHTY ST STE 190
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5739
Mailing Address - Country:US
Mailing Address - Phone:513-544-6421
Mailing Address - Fax:
Practice Address - Street 1:125 DOUGHTY STREET SUITE 190
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-3208
Practice Address - Country:US
Practice Address - Phone:843-792-5217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMPA.3373363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant