Provider Demographics
NPI:1154724607
Name:PIONK, JESSICA L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:PIONK
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:16000 JOHNSTON MEMORIAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-7664
Mailing Address - Country:US
Mailing Address - Phone:276-258-1760
Mailing Address - Fax:276-258-1765
Practice Address - Street 1:16000 JOHNSTON MEMORIAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7664
Practice Address - Country:US
Practice Address - Phone:276-258-1760
Practice Address - Fax:276-258-1765
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2017-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110004743363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01477858OtherRR MEDICARE
VA1154724607Medicaid
VAC09112Medicare UPIN
VA1154724607Medicaid
VAVVF651AMedicare PIN