Healthcare Provider Details

I. General information

NPI: 1477513034
Provider Name (Legal Business Name): JESSICA ELISE BROWN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ELISE LIGHTNER

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 ELMWOOD AVE
KENMORE NY
14217
US

IV. Provider business mailing address

908 NIAGARA FALLS BLVD STE 208
NORTH TONAWANDA NY
14120-2019
US

V. Phone/Fax

Practice location:
  • Phone: 716-447-6100
  • Fax: 716-876-5079
Mailing address:
  • Phone: 716-692-3302
  • Fax: 716-692-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number017770
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: