Provider Demographics
NPI:1295560050
Name:ABOAGYE, JESIKA (NP)
Entity type:Individual
Prefix:
First Name:JESIKA
Middle Name:
Last Name:ABOAGYE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:CA
Mailing Address - Zip Code:92369-7813
Mailing Address - Country:US
Mailing Address - Phone:909-583-4948
Mailing Address - Fax:
Practice Address - Street 1:204 S MACY ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-2041
Practice Address - Country:US
Practice Address - Phone:909-583-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028860363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health