Provider Demographics
NPI:1902204340
Name:O'BRIEN, JESSICA (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:O'BRIEN
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 1:7500 HANOVER PKWY STE 105A
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2011
Mailing Address - Country:US
Mailing Address - Phone:301-220-2220
Mailing Address - Fax:301-220-2224
Practice Address - Street 1:7500 HANOVER PKWY STE 105A
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2011
Practice Address - Country:US
Practice Address - Phone:301-220-2220
Practice Address - Fax:301-220-2224
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA52917363A00000X
DCPA031097363A00000X
SCPA3404363A00000X
AZ7734363A00000X
VA0110-008469363A00000X
MO2022042041363A00000X
NC0010-12772363A00000X
MDC0008241363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant