Healthcare Provider Details

I. General information

NPI: 1568747822
Provider Name (Legal Business Name): JESSICA LYNN MATHENIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LYNN REUTER PA

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 RED HOOK PLAZA SUITE 205
ST THOMAS VI
00802
UM

IV. Provider business mailing address

5000 ESTATE ENIGHED PMB 214
ST JOHN VI
00830
UM

V. Phone/Fax

Practice location:
  • Phone: 340-775-2303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085004185
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085004185
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number106
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: