MEDICARE: JESSICA BRANSON P.A.-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	0004550	CO

General Provider Information

NPI Number	:	1255791059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BRANSON P.A.-C

Provider Business Mailing Address
First Line	:	10103 RIDGEGATE PKWY
Second Line	:	STE 312
City	:	LONE TREE
State	:	CO
Zip	:	80124-5525
Country	:	US
Telephone Number	:	303-788-8888
Fax Number	:	303-790-2567

Provider Business Practice Location Address
First Line	:	755 S PERRY ST STE 100
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1923
Country	:	US
Telephone Number	:	303-688-8989
Fax Number	:	303-688-3482

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

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	10/03/2018

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