Provider Demographics
NPI:1871188094
Name:COLE, JESSICA NORTH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:NORTH
Last Name:COLE
Suffix:
Gender:F
Credentials:PA-C
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 3087
Mailing Address - Street 2:NORTH OAKS PROFESSIONAL BILLING SERVICES
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-3087
Mailing Address - Country:US
Mailing Address - Phone:985-230-3668
Mailing Address - Fax:985-370-7409
Practice Address - Street 1:15813 PAUL VEGA MD DR STE 402
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1426
Practice Address - Country:US
Practice Address - Phone:985-230-7400
Practice Address - Fax:985-230-7401
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA324299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2561260Medicaid