Provider Demographics
NPI:1063635522
Name:YODER, JESSICA ANN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:YODER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11245 HURON ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2806
Mailing Address - Country:US
Mailing Address - Phone:303-338-4545
Mailing Address - Fax:
Practice Address - Street 1:1661 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-2728
Practice Address - Country:US
Practice Address - Phone:540-564-7300
Practice Address - Fax:757-579-8580
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO48080207Q00000X
VA01012685144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063635522Medicaid
CO91259568Medicaid
CO020868OtherKAISER COMMERCIAL NUMBER