Jessica M Fetterman, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

4282 Trout Lilly LN
Manlius, NY 13104-9807

Phone

(315) 877-2402

NPI assigned

Nov 2, 2006

Last updated

Sep 7, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283817600000",
    "number": "1316025679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4282 TROUT LILLY LN",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131049807",
            "telephone_number": "315-877-2402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4282 TROUT LILLY LN",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131049807",
            "telephone_number": "315-877-2402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETTERMAN",
        "first_name": "JESSICA",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-02",
        "last_updated": "2010-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004474",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fairway Management, LLC (inDeed Wellness)
• Fayetteville Manlius School District
• Fayetteville-Manlius Oral Surgery, P.C
• Adam Feck
• Karen Fernandez-Cosgrove, PH.D., LMFT
• Lia Fischi
• Sophie Katherine Fowler
• Janie Friedman, LMT
• Linda B. Friedman, MS, SLP-CCC
• Jade Frost

• Medical Physician Assistant in Manlius, NY
• Providers in Manlius, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.