Provider Demographics
NPI:1386510907
Name:TAYLOR, JESSICA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:114 STONEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18436-4641
Mailing Address - Country:US
Mailing Address - Phone:570-488-5811
Mailing Address - Fax:570-488-2612
Practice Address - Street 1:11 FARVIEW RD
Practice Address - Street 2:
Practice Address - City:WAYMART
Practice Address - State:PA
Practice Address - Zip Code:18472-7700
Practice Address - Country:US
Practice Address - Phone:570-488-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA057109363A00000X
PAOA003375363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant