Provider Demographics
NPI:1891826467
Name:O'BRIEN, JESSICA NICOLE (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:NICOLE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3670 SOUTH BENZING RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-675-5711
Mailing Address - Fax:716-675-1358
Practice Address - Street 1:3670 SOUTH BENZING RD
Practice Address - Street 2:SUITE C
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-675-5711
Practice Address - Fax:716-675-1358
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005077363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0021056603OtherUNIVERA
NY000570066007OtherBCBS
NY02345619Medicaid
NY9511995OtherINDEPENDENT HEALTH
NY0021056603OtherUNIVERA
NY02345619Medicaid