Provider Demographics
NPI:1215639430
Name:PITCHER, JESSE MARIE
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:MARIE
Last Name:PITCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 PARKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307-5830
Mailing Address - Country:US
Mailing Address - Phone:731-592-3761
Mailing Address - Fax:
Practice Address - Street 1:1720 WOODLAWN AVE STE 1
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1300
Practice Address - Country:US
Practice Address - Phone:731-285-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5469363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant