Provider Demographics
NPI:1699749853
Name:ANNIS, JESSICA R (PA-C)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:R
Last Name:ANNIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:130 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9315
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-522-4120
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9350
Practice Address - Country:US
Practice Address - Phone:570-522-4264
Practice Address - Fax:570-522-4155
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA052178363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
139381NYFMedicare PIN
Q54812Medicare UPIN