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NPI Code Detail

MEDICARE: JESSICA CHESNUT

MEDICARE: JESSICA CHESNUT
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 Assistant

General Provider Information

NPI Number : 1942905260
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA CHESNUT
Provider Business Mailing Address
First Line : 2425 HIGHWAY 121
Second Line :
City : BEDFORD
State : TX
Zip : 76021-5011
Country : US
Telephone Number : 817-540-4477
Fax Number : 817-540-5633
Provider Business Practice Location Address
First Line : 3301 GOLDEN TRIANGLE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76177-7165
Country : US
Telephone Number : 817-540-4477
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2023
Last Update Date : 05/12/2023

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Directions to “ JESSICA CHESNUT ” Practice Location

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