Provider Demographics
NPI:1699490516
Name:BECKER, JESSICA ANN (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:BECKER
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 1:6011 ARCHSTONE WAY APT 103
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-5515
Mailing Address - Country:US
Mailing Address - Phone:402-690-5916
Mailing Address - Fax:
Practice Address - Street 1:13875 HEDGEWOOD DR STE 210
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5922
Practice Address - Country:US
Practice Address - Phone:703-434-3633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2869363A00000X
VA0110009658363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant