Healthcare Provider Details

I. General information

NPI: 1386075166
Provider Name (Legal Business Name): JESSICA R HESFORD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE STE 334
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT RD CBO2-3, ATTN - CREDENTIALING
CINCINNATI OH
45219
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-1500
  • Fax: 513-585-1510
Mailing address:
  • Phone: 513-263-8571
  • Fax: 513-263-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004691
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085004942
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: