MEDICARE: JESSICA N PAYMENT 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	PA.0005193	CO
2	363AM0700X	Medical Physician Assistant	PA70038686	WA

General Provider Information

NPI Number	:	1407360571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA N PAYMENT PA-C

Provider Business Mailing Address
First Line	:	PO BOX 5299
Second Line	:	MS: 820-5-PCO
City	:	TACOMA
State	:	WA
Zip	:	98415-0299
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 LEYDEN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-5953
Country	:	US
Telephone Number	:	303-901-9713
Fax Number	:

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

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	02/10/2026

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