MEDICARE: JESSIE WETHERBE F.N.P.

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	207VX0201X	Gynecologic Oncology Physician	207V00000X	CA
2	363LF0000X	Family Nurse Practitioner	95002751	CA

General Provider Information

NPI Number	:	1336516632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE WETHERBE F.N.P.

Provider Business Mailing Address
First Line	:	7418 W 89TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3419
Country	:	US
Telephone Number	:	310-730-3723
Fax Number	:

Provider Business Practice Location Address
First Line	:	8475 S VAN NESS AVE
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90305-1562
Country	:	US
Telephone Number	:	310-530-5363
Fax Number	:

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

Provider Enumeration Date	:	08/21/2015
Last Update Date	:	02/18/2025

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