Provider Demographics
NPI:1063230076
Name:FATE, JESSICA LEAH (APRN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEAH
Last Name:FATE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 CAMBERWELL DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2604
Mailing Address - Country:US
Mailing Address - Phone:412-478-5027
Mailing Address - Fax:
Practice Address - Street 1:160 HOLLYWOOD DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5600
Practice Address - Country:US
Practice Address - Phone:412-362-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030713363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner