Provider Demographics
NPI:1801558549
Name:HENDRICKS, JESSANA MADELYN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JESSANA
Middle Name:MADELYN
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSANA
Other - Middle Name:MADELYN
Other - Last Name:WESTBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2275 HEALTH CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8809
Mailing Address - Country:US
Mailing Address - Phone:540-689-4810
Mailing Address - Fax:
Practice Address - Street 1:2275 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8809
Practice Address - Country:US
Practice Address - Phone:540-689-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-007960363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical