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General NPI Number Information
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NPI Number | 1972980639
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Entity Type | Individual
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Provider Name | JESIKA HARRELL PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 500 EAST BENSON BLVD SUITE 103
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City | ANCHORAGE
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State | AK
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Zip | 99623
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Country | US
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Telephone | 907-250-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 500 EAST BENSON BLVD, SUITE 103
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City | ANCHORAGE
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State | AK
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Zip | 99623-7255
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Country | US
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Telephone | 907-250-2511
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Fax | 907-250-2511
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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 | PADA1252
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License Number State | AK
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