Provider Demographics
NPI:1629588108
Name:MYERS, JESSIE JEAN
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:JEAN
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 FOREST RD FL 2
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3720
Mailing Address - Country:US
Mailing Address - Phone:778-297-0111
Mailing Address - Fax:
Practice Address - Street 1:3520 FOREST RD FL 2
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3720
Practice Address - Country:US
Practice Address - Phone:877-296-0111
Practice Address - Fax:517-347-8393
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant