Healthcare Provider Details

I. General information

NPI: 1598064149
Provider Name (Legal Business Name): JESSICA LEA PROBERT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S COLORADO BLVD PH NORTH
DENVER CO
80246-1904
US

IV. Provider business mailing address

8300 ESTERS BLVD STE 900
IRVING TX
75063-2233
US

V. Phone/Fax

Practice location:
  • Phone: 415-424-4266
  • Fax: 425-520-6633
Mailing address:
  • Phone: 415-424-4266
  • Fax: 303-338-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8647
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58490
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115328
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14389
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11899
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2020031690
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2504
License Number StateNV
# 8
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0003153
License Number StateCO
# 9
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61097382
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: