Provider Demographics
NPI:1851499107
Name:MATTHEWS, JESSICA T (MD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:T
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 MAJESTIC WAY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5452
Mailing Address - Country:US
Mailing Address - Phone:928-925-6574
Mailing Address - Fax:928-771-5787
Practice Address - Street 1:1003 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1641
Practice Address - Country:US
Practice Address - Phone:928-771-5786
Practice Address - Fax:928-771-5787
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI045521207P00000X
AZ37844207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34446800Medicaid
WI34446800Medicaid
WI003054170Medicare ID - Type Unspecified