Provider Demographics
NPI:1346670478
Name:CHAUDRY, JESSICA KATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATHERINE
Last Name:CHAUDRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:KATHERINE
Other - Last Name:RITCHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:121 N NYES RD
Practice Address - Street 2:SUITE A
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-3247
Practice Address - Country:US
Practice Address - Phone:717-657-4040
Practice Address - Fax:717-671-9038
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003200363A00000X
PAMA056640363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA341293F6KOtherMEDICARE PTAN