Healthcare Provider Details

I. General information

NPI: 1699335059
Provider Name (Legal Business Name): JESSICA GAWRYS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA WOOD

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142A DANIELSON PIKE
FOSTER RI
02825-1485
US

IV. Provider business mailing address

142A DANIELSON PIKE
FOSTER RI
02825-1485
US

V. Phone/Fax

Practice location:
  • Phone: 401-647-3702
  • Fax:
Mailing address:
  • Phone: 401-647-3702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: