Provider Demographics
NPI:1164898748
Name:JOSSERAND, JESSICA LAURENE (C-PNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAURENE
Last Name:JOSSERAND
Suffix:
Gender:F
Credentials:C-PNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LAURENE
Other - Last Name:KEESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:C-PNP
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:B545
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-4392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0991573363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics