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General NPI Number Information
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NPI Number | 1730754375
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Entity Type | Individual
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Provider Name | JESSICA FORRY LEBRUN PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 101 E WOOD ST
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City | SPARTANBURG
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State | SC
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Zip | 29303-3040
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Country | US
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Telephone | 864-560-5444
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Fax | 864-560-6017
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Provider Business Mailing Address
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Address Line | 104 VESPER CIR
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City | MAULDIN
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State | SC
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Zip | 29662-2520
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Country | US
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Telephone | 864-560-5444
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4060
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License Number State | SC
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