Provider Demographics
NPI:1255052999
Name:BAKHTIARI, JESSICA ANNE (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:BAKHTIARI
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:JAMESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:25 MOGUL MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-9616
Mailing Address - Country:US
Mailing Address - Phone:775-772-0324
Mailing Address - Fax:
Practice Address - Street 1:3101 SUNSET TER
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-3846
Practice Address - Country:US
Practice Address - Phone:775-772-0324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95283787163W00000X
NV816659163W00000X
CA95033915363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse