Provider Demographics
NPI:1598064149
Name:PROBERT, JESSICA LEA (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEA
Last Name:PROBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 ESTERS BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2233
Mailing Address - Country:US
Mailing Address - Phone:415-424-4266
Mailing Address - Fax:303-338-0443
Practice Address - Street 1:720 S COLORADO BLVD PH NORTH
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1904
Practice Address - Country:US
Practice Address - Phone:415-424-4266
Practice Address - Fax:425-520-6633
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8647363A00000X
CA58490363A00000X
FLPA9115328363A00000X
TXPA14389363A00000X
GA11899363A00000X
MO2020031690363A00000X
NVPA2504363A00000X
COPA.0003153363A00000X
WAPA61097382363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant