Provider Demographics
NPI:1376019208
Name:RICHIE, JESSIE (PA-C)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:RICHIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:
Other - Last Name:PARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1001 WILSON BLVD APT 1101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2261
Mailing Address - Country:US
Mailing Address - Phone:561-389-1684
Mailing Address - Fax:
Practice Address - Street 1:2220 SE OCEAN BLVD STE 301
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3301
Practice Address - Country:US
Practice Address - Phone:772-220-3339
Practice Address - Fax:772-286-2635
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant