Healthcare Provider Details

I. General information

NPI: 1336516632
Provider Name (Legal Business Name): JESSIE WETHERBE F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8475 S VAN NESS AVE
INGLEWOOD CA
90305-1562
US

IV. Provider business mailing address

7418 W 89TH ST
LOS ANGELES CA
90045-3419
US

V. Phone/Fax

Practice location:
  • Phone: 310-530-5363
  • Fax:
Mailing address:
  • Phone: 310-730-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number207V00000X
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: