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General NPI Number Information
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NPI Number | 1427451996
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Entity Type | Individual
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Provider Name | JESSICA BERRES HOULIHAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/29/2014
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 2400 GREATSTONE PT
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City | LEXINGTON
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State | KY
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Zip | 40504-3274
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Country | US
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Telephone | 859-323-6211
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Fax | 859-323-1315
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Provider Business Mailing Address
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Address Line | 1804 BIMINI RD
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City | LEXINGTON
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State | KY
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Zip | 40502-2840
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Country | US
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Telephone | 859-396-8125
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1966
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA1966
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1966
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License Number State | KY
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