Provider Demographics
NPI:1265762850
Name:KNAUSS, JESSICA KT (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KT
Last Name:KNAUSS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:K
Other - Last Name:TEDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 FAIRMONT ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-6015
Mailing Address - Country:US
Mailing Address - Phone:610-432-4122
Mailing Address - Fax:612-432-6677
Practice Address - Street 1:1401 FAIRMONT ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-6015
Practice Address - Country:US
Practice Address - Phone:610-432-4122
Practice Address - Fax:612-432-6677
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054267363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical