MEDICARE: MRS. JESSICA LYNN ANDERSON 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	MED-PAC-LIC-575	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417115791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA LYNN ANDERSON PA-C

Provider Business Mailing Address
First Line	:	915 HIGHLAND BLVD
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-6902
Country	:	US
Telephone Number	:	406-414-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3905 WELLNESS WAY STE 3B
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-2402
Country	:	US
Telephone Number	:	406-414-5950
Fax Number	:

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

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	01/21/2026

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