Healthcare Provider Details

I. General information

NPI: 1891323671
Provider Name (Legal Business Name): JESSICA WEST PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SIMS DR
SYRACUSE NY
13244-4412
US

IV. Provider business mailing address

150 SIMS DR
SYRACUSE NY
13244-4412
US

V. Phone/Fax

Practice location:
  • Phone: 315-443-8000
  • Fax:
Mailing address:
  • Phone: 314-443-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025809
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: