MEDICARE: MRS. JESSICA LANE FRIZZELL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085-003006	IL
2	363AM0700X	Medical Physician Assistant	PA1782	KY
3	363A00000X	Physician Assistant	PA1782	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306036603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA LANE FRIZZELL PA-C

Provider Business Mailing Address
First Line	:	100 KIANA CT APT B
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-6767
Country	:	US
Telephone Number	:	270-408-6100
Fax Number	:	270-408-6112

Provider Business Practice Location Address
First Line	:	100 KIANA COURT
Second Line	:	SUITE B
City	:	PADUCAH
State	:	KY
Zip	:	42001
Country	:	US
Telephone Number	:	270-408-6100
Fax Number	:	270-408-6112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	03/19/2026

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