Provider Demographics
NPI:1457356123
Name:JESSEPH, RACHELLE L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:L
Last Name:JESSEPH
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:310 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2129
Mailing Address - Country:US
Mailing Address - Phone:316-264-3505
Mailing Address - Fax:316-264-0908
Practice Address - Street 1:1923 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3405
Practice Address - Country:US
Practice Address - Phone:316-630-9300
Practice Address - Fax:316-262-4887
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2021-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS1500853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSQ26333Medicare UPIN