Provider Demographics
NPI:1740251115
Name:BARTLEY, JESSAMYN D (PA)
Entity type:Individual
Prefix:
First Name:JESSAMYN
Middle Name:D
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JESSAMYN
Other - Middle Name:C
Other - Last Name:DEEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 22265
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4473
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:14 RICHLAND MEDICAL PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6882
Practice Address - Country:US
Practice Address - Phone:803-296-9200
Practice Address - Fax:803-296-9697
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052259207X00000X
SC1185363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA16692121OtherMEDICARE
SCSC6674E878Medicare UPIN
SCAA16692121OtherMEDICARE