Provider Demographics
NPI:1164088944
Name:VADOVICKY, JESSICA GERNER (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:GERNER
Last Name:VADOVICKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:GERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4201 LONG BEACH BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2020
Mailing Address - Country:US
Mailing Address - Phone:562-427-3897
Mailing Address - Fax:562-595-7703
Practice Address - Street 1:4201 LONG BEACH BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2020
Practice Address - Country:US
Practice Address - Phone:562-427-3897
Practice Address - Fax:562-595-7703
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011038363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health