Provider Demographics
NPI:1902135833
Name:FAULKNER, JESSICA M (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7495 STATE RD
Mailing Address - Street 2:SUITE 335
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-2498
Mailing Address - Country:US
Mailing Address - Phone:513-232-5512
Mailing Address - Fax:513-232-3341
Practice Address - Street 1:7495 STATE RD
Practice Address - Street 2:SUITE 335
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2498
Practice Address - Country:US
Practice Address - Phone:513-232-5512
Practice Address - Fax:513-232-3341
Is Sole Proprietor?:No
Enumeration Date:2009-12-24
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50003012363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical