Healthcare Provider Details

I. General information

NPI: 1033045653
Provider Name (Legal Business Name): LAUREN MARIE JESSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 UPPER VIOLET RD
BOZEMAN MT
59718-7784
US

IV. Provider business mailing address

309 UPPER VIOLET RD
BOZEMAN MT
59718-7784
US

V. Phone/Fax

Practice location:
  • Phone: 513-535-2658
  • Fax:
Mailing address:
  • Phone: 513-535-2658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMED-PAC-LIC-174055
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: