Provider Demographics
NPI:1427822873
Name:GIESEL, JESSICA ROSALIE (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSALIE
Last Name:GIESEL
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 1:2023 CHEROKEE PKWY
Mailing Address - Street 2:APT 19
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204
Mailing Address - Country:US
Mailing Address - Phone:570-406-6097
Mailing Address - Fax:
Practice Address - Street 1:3 AUDUBON PLAZA DR STE LL2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1360
Practice Address - Country:US
Practice Address - Phone:502-583-1697
Practice Address - Fax:502-636-8997
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC078363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical