Provider Demographics
NPI:1043365026
Name:MATHISEN, JESSICA A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:A
Last Name:MATHISEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1215 PLEASANT STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50390-1409
Mailing Address - Country:US
Mailing Address - Phone:515-241-5710
Mailing Address - Fax:515-241-8004
Practice Address - Street 1:1215 PLEASANT STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50390-1409
Practice Address - Country:US
Practice Address - Phone:515-241-5710
Practice Address - Fax:515-241-8004
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA01747363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01747OtherPHYSICIAN ASSISTANCE LICE