Provider Demographics
NPI:1417671165
Name:PETRICK, JESSICA R (NP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:R
Last Name:PETRICK
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:251 SALINA MEADOWS PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212
Mailing Address - Country:US
Mailing Address - Phone:315-464-2000
Mailing Address - Fax:315-464-2010
Practice Address - Street 1:655 MADISON STREET
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-473-8700
Practice Address - Fax:315-473-8707
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2024-11-07
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Provider Licenses
StateLicense IDTaxonomies
NY383447208000000X, 363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner