Healthcare Provider Details

I. General information

NPI: 1740855444
Provider Name (Legal Business Name): JESSICA BADGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 FOULK RD STE 1A
WILMINGTON DE
19803-3733
US

IV. Provider business mailing address

701 FOULK RD STE 1A
WILMINGTON DE
19803-3733
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-0001
  • Fax:
Mailing address:
  • Phone: 302-731-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC5-0011772
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: