Provider Demographics
NPI:1760677629
Name:ROSS, JESSICA ANN (PA-C, ATC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANN
Last Name:ROSS
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPT 358
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:360-733-2092
Mailing Address - Fax:360-788-6042
Practice Address - Street 1:3015 SQUALICUM PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1945
Practice Address - Country:US
Practice Address - Phone:360-733-2092
Practice Address - Fax:360-788-6042
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005269363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant