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General NPI Number Information
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NPI Number | 1679573034
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Entity Type | Individual
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Provider Name | TIMOTHY A JESSIE MD
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 207 N TOWNLINE RD STE 101
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City | LAGRANGE
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State | IN
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Zip | 46761-1325
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Country | US
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Telephone | 260-463-9335
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Fax | 260-463-9334
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Provider Business Mailing Address
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Address Line | 11109 PARKVIEW PLAZA DR # 117
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City | FORT WAYNE
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State | IN
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Zip | 46845-1701
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Country | US
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Telephone |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD2020-0191
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35083403
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 200501327
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | D73747
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License Number State | MD
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 32580
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License Number State | KS
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Taxonomy #6
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01076415A
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License Number State | IN
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