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NPI Code Detail

MEDICARE: JESSIE SOPHIA BENNETT PA-C

MEDICARE: JESSIE SOPHIA BENNETT 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
1363A00000XPhysician Assistant1222736CA

General Provider Information

NPI Number : 1811838303
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSIE SOPHIA BENNETT PA-C
Provider Business Mailing Address
First Line : PO BOX 255228
Second Line :
City : SACRAMENTO
State : CA
Zip : 95865-5228
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3100 DOUGLAS BLVD
Second Line :
City : ROSEVILLE
State : CA
Zip : 95661-3866
Country : US
Telephone Number : 916-774-8300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2026
Last Update Date : 05/18/2026

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Directions to “ JESSIE SOPHIA BENNETT PA-C” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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