Provider Demographics
NPI:1578678546
Name:REISSIG, JAMI N (PA)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:N
Last Name:REISSIG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2256
Mailing Address - Country:US
Mailing Address - Phone:972-215-7700
Mailing Address - Fax:972-215-7711
Practice Address - Street 1:2001 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 255
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2256
Practice Address - Country:US
Practice Address - Phone:972-215-7700
Practice Address - Fax:972-215-7711
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03807363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D1838Medicare PIN