Provider Demographics
NPI:1932437662
Name:WATSON, JESSICA LEIGH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEIGH
Last Name:WATSON
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 1:2114 HIGHWAY 41 STE 105
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-6201
Mailing Address - Country:US
Mailing Address - Phone:843-388-9000
Mailing Address - Fax:843-388-6937
Practice Address - Street 1:2114 HIGHWAY 41 STE 105
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466
Practice Address - Country:US
Practice Address - Phone:843-388-9000
Practice Address - Fax:843-388-6937
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2054363AM0700X
MDC0004103363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1848PAMedicaid
SCSC3066I711OtherMEDICARE PIN
SCSC30666882Medicare PIN