Provider Demographics
NPI:1083853246
Name:HORWATH, JESSICA DODGE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DODGE
Last Name:HORWATH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5929 BALCONES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4280
Mailing Address - Country:US
Mailing Address - Phone:512-550-1800
Mailing Address - Fax:
Practice Address - Street 1:5656 BEE CAVES RD STE C104
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5281
Practice Address - Country:US
Practice Address - Phone:512-550-1800
Practice Address - Fax:855-828-0878
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05278363A00000X, 363AM0700X
NY011867363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204000801Medicaid
TX8L12943Medicare PIN