Provider Demographics
NPI:1467127902
Name:HENDERSON, JESSICA LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1110 PROFESSIONAL CT STE 201
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5945
Mailing Address - Country:US
Mailing Address - Phone:240-707-6920
Mailing Address - Fax:240-707-6926
Practice Address - Street 1:1110 PROFESSIONAL CT STE 201
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5945
Practice Address - Country:US
Practice Address - Phone:240-707-6920
Practice Address - Fax:240-707-6926
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2024-08-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant