Provider Demographics
NPI:1811919939
Name:OWSLEY, JESSICA BLAKE (FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BLAKE
Last Name:OWSLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:CATHERINE
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:673 MICHAW ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-3599
Mailing Address - Country:US
Mailing Address - Phone:904-583-9972
Mailing Address - Fax:612-659-7101
Practice Address - Street 1:1361 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1978
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:612-659-7101
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC90652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily