Provider Demographics
NPI:1750532701
Name:PRESCOTT, JESSICA REAVIS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:REAVIS
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:514 MCMANUS WAY
Mailing Address - Street 2:#T514
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8506
Mailing Address - Country:US
Mailing Address - Phone:410-227-3622
Mailing Address - Fax:
Practice Address - Street 1:514 MCMANUS WAY
Practice Address - Street 2:#T514
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-8506
Practice Address - Country:US
Practice Address - Phone:410-227-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant