MEDICARE: JESSY CLAIRE OSBORNE 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	363AM0700X	Medical Physician Assistant	MA053148	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA053148	OTHER	PA	STATE LICENSE

General Provider Information

NPI Number	:	1548457864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSY CLAIRE OSBORNE PA-C

Provider Business Mailing Address
First Line	:	122 S WASHINGTON ST
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16001-5752
Country	:	US
Telephone Number	:	724-283-6668
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 S WASHINGTON ST
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16001-5752
Country	:	US
Telephone Number	:	724-283-6668
Fax Number	:

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

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	05/12/2009

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