Healthcare Provider Details

I. General information

NPI: 1861001984
Provider Name (Legal Business Name): JESSIKA HEFFERNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSIKA ROBBINS

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MUNROE ST
LYNN MA
01901-1520
US

IV. Provider business mailing address

615 ELSINORE PL STE 200
CINCINNATI OH
45202-1457
US

V. Phone/Fax

Practice location:
  • Phone: 844-265-8661
  • Fax:
Mailing address:
  • Phone: 833-510-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4905
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: