Provider Demographics
NPI:1699222042
Name:PAINTER, JESSICA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:PAINTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:VA
Mailing Address - Zip Code:22849-1263
Mailing Address - Country:US
Mailing Address - Phone:540-652-9100
Mailing Address - Fax:540-652-9119
Practice Address - Street 1:505 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:VA
Practice Address - Zip Code:22849-1263
Practice Address - Country:US
Practice Address - Phone:540-652-9100
Practice Address - Fax:540-652-9119
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV363A00000X
VA0110006170363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1699222042Medicaid