Provider Demographics
NPI:1730995077
Name:LIBICER, JESSICA LAIL (PA-S)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAIL
Last Name:LIBICER
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:PAULINE
Other - Last Name:LAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:BUIES CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:27506-1090
Mailing Address - Country:US
Mailing Address - Phone:800-760-9734
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1090
Practice Address - Street 2:
Practice Address - City:BUIES CREEK
Practice Address - State:NC
Practice Address - Zip Code:27506-1090
Practice Address - Country:US
Practice Address - Phone:800-760-9734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program