Healthcare Provider Details

I. General information

NPI: 1669123055
Provider Name (Legal Business Name): JESSICA LEE LEVASSEUR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WILLOW CREEK RD STE 3200
PRESCOTT AZ
86301-1614
US

IV. Provider business mailing address

844 PANORAMA RDG
MOUNT VERNON WA
98273-9140
US

V. Phone/Fax

Practice location:
  • Phone: 928-771-5595
  • Fax: 928-771-5596
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number11843
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA61263842
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: