Provider Demographics
NPI:1043510050
Name:STALEY, JESSICA N (PA-C)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:N
Last Name:STALEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4634 HILLS AND DALES RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-1510
Mailing Address - Country:US
Mailing Address - Phone:330-477-0255
Mailing Address - Fax:330-479-0392
Practice Address - Street 1:4634 HILLS AND DALES RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1510
Practice Address - Country:US
Practice Address - Phone:330-477-0255
Practice Address - Fax:330-479-0392
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH003178363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical