Healthcare Provider Details

I. General information

NPI: 1518375591
Provider Name (Legal Business Name): JESSICA BROOKE METZGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-5401
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-8686
  • Fax: 859-301-8690
Mailing address:
  • Phone: 859-301-8686
  • Fax: 859-301-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001710A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number99062936A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2095
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: