Provider Demographics
NPI:1326386145
Name:HANSON, JESSICA LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LYNN
Last Name:HANSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST
Mailing Address - Street 2:SUITE 2070
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1521
Mailing Address - Country:US
Mailing Address - Phone:713-704-6731
Mailing Address - Fax:713-704-1796
Practice Address - Street 1:4141 VISTA RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2113
Practice Address - Country:US
Practice Address - Phone:713-947-3100
Practice Address - Fax:713-947-6103
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA08088363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035TDOtherBCBSTX GRP RECORD NUMBER
TXDB6392OtherGRP RAILROAD MDCR PTAN
TX153449704OtherHARRIS COUNTY GRP TPI
TX302679101OtherBRAZORIA COUNTY GRP TPI
TX00106WOtherHARRIS COUNTY GRP MDCR PTAN
TX00X185OtherBRAZORIA COUNTY GRP PTAN
TX274019YNBTOtherMEDICARE PTAN FOR HARRIS CO
TX274019YPXVOtherMEDICARE PTAN FOR BRAZORIA CO