Healthcare Provider Details

I. General information

NPI: 1487698908
Provider Name (Legal Business Name): JENNIFER DEBORAH LEVESQUE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 DAVOL ST
FALL RIVER MA
02720-1028
US

IV. Provider business mailing address

775 DAVOL ST STE 3
FALL RIVER MA
02720-1028
US

V. Phone/Fax

Practice location:
  • Phone: 774-488-5888
  • Fax: 508-674-8880
Mailing address:
  • Phone: 774-488-5888
  • Fax: 508-674-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1715
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1715
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: