Provider Demographics
NPI:1720385453
Name:PRATHER, JESSICA MICHELLE (NP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MICHELLE
Last Name:PRATHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9508 STOCKDALE HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3623
Mailing Address - Country:US
Mailing Address - Phone:661-345-1400
Mailing Address - Fax:
Practice Address - Street 1:9508 STOCKDALE HWY STE 150
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3623
Practice Address - Country:US
Practice Address - Phone:661-345-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20219363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20219OtherNP LICENSE
CA664659OtherRN LICENSE