Provider Demographics
NPI:1891292512
Name:SCHNEIDER, JESSICA ELISE (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELISE
Last Name:SCHNEIDER
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 1:1045 KINGS PARK RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5433
Mailing Address - Country:US
Mailing Address - Phone:901-230-1331
Mailing Address - Fax:
Practice Address - Street 1:808 OAK AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:CA
Practice Address - Zip Code:93927-5648
Practice Address - Country:US
Practice Address - Phone:831-674-5334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55361363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant