Provider Demographics
NPI:1063050540
Name:BURGESS, JESSICA M (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:BURGESS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SE 7TH AVE STE 2500
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4157
Mailing Address - Country:US
Mailing Address - Phone:503-844-8280
Mailing Address - Fax:503-621-2235
Practice Address - Street 1:333 SE 7TH AVE STE 2500
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4157
Practice Address - Country:US
Practice Address - Phone:503-844-8280
Practice Address - Fax:503-621-2235
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA215797363A00000X
WADI60909406133V00000X
ORLD-D-10194800133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered