Healthcare Provider Details

I. General information

NPI: 1174431787
Provider Name (Legal Business Name): JESSICA L NIGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 S PONDEROSA ST
PAYSON AZ
85541-5542
US

IV. Provider business mailing address

807 S PONDEROSA ST
PAYSON AZ
85541-5542
US

V. Phone/Fax

Practice location:
  • Phone: 928-471-3222
  • Fax:
Mailing address:
  • Phone: 928-471-3222
  • Fax: 928-951-5693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number215875
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: