Provider Demographics
NPI:1760963698
Name:ANDERIES, JESSICA LIL (PA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LIL
Last Name:ANDERIES
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:217 W CATALDO AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2217
Practice Address - Country:US
Practice Address - Phone:509-747-6194
Practice Address - Fax:509-838-0824
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60985955363A00000X
WA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant