Provider Demographics
NPI:1619233913
Name:BROWN, JESSICA JEANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEANNE
Last Name:BROWN
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 1:1804 W MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2346
Mailing Address - Country:US
Mailing Address - Phone:405-802-9631
Mailing Address - Fax:
Practice Address - Street 1:4845 WEITZEL ST STE 101
Practice Address - Street 2:
Practice Address - City:TIMNATH
Practice Address - State:CO
Practice Address - Zip Code:80547
Practice Address - Country:US
Practice Address - Phone:970-494-2626
Practice Address - Fax:970-494-2627
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004356208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics