Healthcare Provider Details

I. General information

NPI: 1922589548
Provider Name (Legal Business Name): JESSY MACKENZIE ARTHURS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

892 AEROVISTA PL STE 120
SAN LUIS OBISPO CA
93401-8054
US

IV. Provider business mailing address

PO BOX 1296
TEMPLETON CA
93465-1296
US

V. Phone/Fax

Practice location:
  • Phone: 805-544-5567
  • Fax:
Mailing address:
  • Phone: 805-610-2516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPA56033
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number56033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: