MEDICARE: JESSIE LEIGH WILSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	027733	NY

General Provider Information

NPI Number	:	1407513773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE LEIGH WILSON PA-C

Provider Business Mailing Address
First Line	:	100 KINGS HWY S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 CULVER RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14609-1716
Country	:	US
Telephone Number	:	585-336-5320
Fax Number	:	585-697-1598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2021
Last Update Date	:	02/03/2026

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