Provider Demographics
NPI:1407446925
Name:MATTHEWS, JESSICA LEE (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:MATTHEWS
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 1:1161 ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3841
Mailing Address - Country:US
Mailing Address - Phone:228-244-9910
Mailing Address - Fax:
Practice Address - Street 1:1161 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3841
Practice Address - Country:US
Practice Address - Phone:228-244-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant