Healthcare Provider Details

I. General information

NPI: 1699285635
Provider Name (Legal Business Name): MICHAEL JESSUP FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 06/13/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ZEAMER AVE
JBER AK
99506-3702
US

IV. Provider business mailing address

673 MDG/JB ELMENDORF-RICHARDSON 5955 ZEAMER AVE
ANCHORAGE AK
99506
US

V. Phone/Fax

Practice location:
  • Phone: 79-580-2030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11007310
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9405402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: