Healthcare Provider Details

I. General information

NPI: 1942581558
Provider Name (Legal Business Name): JESSICA MILLER ROBERTS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LINDSAY MILLER PA-C

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 1ST ST STE A
SAN FRANCISCO CA
94105-2661
US

IV. Provider business mailing address

308 CARRIAGE HILL DR
EASLEY SC
29642-7786
US

V. Phone/Fax

Practice location:
  • Phone: 888-803-3370
  • Fax: 888-803-3331
Mailing address:
  • Phone: 888-803-3370
  • Fax: 888-803-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2597
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13578808-1206
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004225
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA054783
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66333
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110009664
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7633
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: