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General NPI Number Information
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NPI Number | 1346351764
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Entity Type | Individual
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Provider Name | JESSIE SUMNER PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 1130 COUNTRY CLUB DR STE E
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City | MADERA
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State | CA
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Zip | 93638-2691
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Country | US
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Telephone | 559-664-4000
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Fax | 559-615-5224
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Provider Business Mailing Address
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Address Line | 344 E 6TH ST
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City | MADERA
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State | CA
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Zip | 93638-3631
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Country | US
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Telephone | 559-664-4000
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Fax | 559-675-5224
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA13433
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1028699
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License Number State | CA
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