Provider Demographics
NPI:1972386498
Name:GILL, JESSICA LYNN (PA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:GILL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:131 CALIFORNIA DR APT 307
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6680
Mailing Address - Country:US
Mailing Address - Phone:716-270-3826
Mailing Address - Fax:
Practice Address - Street 1:139 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5369
Practice Address - Country:US
Practice Address - Phone:716-433-6711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant