Healthcare Provider Details

I. General information

NPI: 1316686652
Provider Name (Legal Business Name): JESSICA HELEN RESNICK WHISONANT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 S MCCLINTOCK DR STE 101
TEMPE AZ
85283-3393
US

IV. Provider business mailing address

2108 E THOMAS RD
PHOENIX AZ
85016-7761
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-4550
  • Fax: 602-933-8956
Mailing address:
  • Phone: 602-933-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number011727
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number011727
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: