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General NPI Number Information
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NPI Number | 1568747822
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Entity Type | Individual
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Provider Name | JESSICA LYNN MATHENIA PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 6500 RED HOOK PLAZA SUITE 205
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City | ST THOMAS
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State | VI
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Zip | 00802
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Country | UM
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Telephone | 340-775-2303
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 ESTATE ENIGHED PMB 214
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City | ST JOHN
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State | VI
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Zip | 00830
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Country | UM
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085004185
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085004185
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 106
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License Number State | VI
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