Provider Demographics
NPI:1942209119
Name:HARVEY, JESSE JAMES (PA)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:JAMES
Last Name:HARVEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N SAN SABA STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3196
Mailing Address - Country:US
Mailing Address - Phone:210-277-1418
Mailing Address - Fax:210-277-1458
Practice Address - Street 1:5495 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1871
Practice Address - Country:US
Practice Address - Phone:725-726-7914
Practice Address - Fax:210-277-1458
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2493363A00000X
TXPA03903363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q14588Medicare UPIN
8D5388Medicare ID - Type Unspecified