Healthcare Provider Details

I. General information

NPI: 1205581881
Provider Name (Legal Business Name): JESSICA LEIGH ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LEIGH CARL

II. Dates (important events)

Enumeration Date: 02/13/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

V. Phone/Fax

Practice location:
  • Phone: 412-864-9447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN623082
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP023541
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: