Healthcare Provider Details

I. General information

NPI: 1235178302
Provider Name (Legal Business Name): JESSICA MARIE CAIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MARIE CAIN PA-C, AQH, MPAS

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 GLENN MITCHELL DR STE 200
VIRGINIA BEACH VA
23456-0168
US

IV. Provider business mailing address

1950 GLENN MITCHELL DR STE 200
VIRGINIA BEACH VA
23456-0168
US

V. Phone/Fax

Practice location:
  • Phone: 757-507-0600
  • Fax: 757-507-0600
Mailing address:
  • Phone: 757-507-0600
  • Fax: 757-507-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110012006
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number104050
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: