MEDICARE: JESSICA LOUISE BARRETT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1013599752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LOUISE BARRETT PA-C

Provider Business Mailing Address
First Line	:	264 NEW SHACKLE ISLAND RD STE 107
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-2481
Country	:	US
Telephone Number	:	615-824-4244
Fax Number	:	615-824-5916

Provider Business Practice Location Address
First Line	:	264 NEW SHACKLE ISLAND RD STE 107
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-2481
Country	:	US
Telephone Number	:	615-824-4244
Fax Number	:	615-824-5916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	03/07/2026

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