Provider Demographics
NPI:1093327744
Name:BATTERSON, JESSICA A (MSN, RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:BATTERSON
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29936 CLEAR WATER DR
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-7454
Mailing Address - Country:US
Mailing Address - Phone:909-801-1973
Mailing Address - Fax:
Practice Address - Street 1:29936 CLEAR WATER DR
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-7454
Practice Address - Country:US
Practice Address - Phone:909-801-1973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily