Provider Demographics
NPI:1801344601
Name:WAATTI, JESSICA ANN (PA)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANN
Last Name:WAATTI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MARY JANE LN
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-3557
Mailing Address - Country:US
Mailing Address - Phone:443-252-1373
Mailing Address - Fax:
Practice Address - Street 1:4755 OLGLETOWN-STANTON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-9636
Practice Address - Country:US
Practice Address - Phone:130-273-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500717752Medicaid
WA2079317Medicaid