MEDICARE: MS. JESSICA ALISON 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	363AS0400X	Surgical Physician Assistant	005939	GA

General Provider Information

NPI Number	:	1578873154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA ALISON PA-C

Provider Business Mailing Address
First Line	:	2555 E 13TH ST STE 110
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-5134
Country	:	US
Telephone Number	:	970-820-6140
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 E 13TH ST STE 110
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-5134
Country	:	US
Telephone Number	:	970-820-4264
Fax Number	:

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

Provider Enumeration Date	:	10/15/2010
Last Update Date	:	10/13/2017

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