Healthcare Provider Details

I. General information

NPI: 1699246850
Provider Name (Legal Business Name): JESSICA LYNNE CAPPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S MAIN ST
JAMESTOWN NY
14701-6626
US

IV. Provider business mailing address

1350 WHITETAIL LANE
JAMESTOWN NY
14701
US

V. Phone/Fax

Practice location:
  • Phone: 716-489-3152
  • Fax:
Mailing address:
  • Phone: 716-720-0706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number343184
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343184
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: