Provider Demographics
NPI:1942855549
Name:ROBINSON, JESSICA GUNN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:GUNN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 EXCHANGE DR
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-9198
Mailing Address - Country:US
Mailing Address - Phone:803-424-2207
Mailing Address - Fax:803-408-3282
Practice Address - Street 1:804 RUNAWAY BAY LN APT F
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2961
Practice Address - Country:US
Practice Address - Phone:704-280-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant