Provider Demographics
NPI:1205803533
Name:SEWELL, JESSICA MARY JEAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MARY JEAN
Last Name:SEWELL
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 1:8817 BELAIR RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2425
Mailing Address - Country:US
Mailing Address - Phone:410-529-6440
Mailing Address - Fax:410-529-6793
Practice Address - Street 1:103 BATA BLVD STE A
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1420
Practice Address - Country:US
Practice Address - Phone:410-575-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002651363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical