Healthcare Provider Details

I. General information

NPI: 1447643986
Provider Name (Legal Business Name): JESSICA KATHLEEN FICHTER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CAMPBELL DR
AVELLA PA
15312-2738
US

IV. Provider business mailing address

297 MCKEE RD
WASHINGTON PA
15301-7755
US

V. Phone/Fax

Practice location:
  • Phone: 724-587-3472
  • Fax: 724-587-5947
Mailing address:
  • Phone: 724-986-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016066
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014848
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN82807
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number3016066
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: