Provider Demographics
NPI:1669459954
Name:DIAMOND, JESSICA M (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:DIAMOND
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 1:127 ONEIDA VALLEY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2251
Mailing Address - Country:US
Mailing Address - Phone:866-620-6761
Mailing Address - Fax:724-282-3043
Practice Address - Street 1:127 ONEIDA VALLEY RD STE 400
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2251
Practice Address - Country:US
Practice Address - Phone:866-620-6761
Practice Address - Fax:724-282-3043
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002811363A00000X
PAMA051517363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ18067Medicare UPIN