Healthcare Provider Details

I. General information

NPI: 1871934869
Provider Name (Legal Business Name): JESSICA WILLETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W HOSPITAL RD
FRENCH CAMP CA
95231-9693
US

IV. Provider business mailing address

85 5TH AVE FL 8
NEW YORK NY
10003-3019
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-6000
  • Fax: 209-468-7042
Mailing address:
  • Phone: 646-863-1411
  • Fax: 516-864-4618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20044
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA138328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: