Provider Demographics
NPI:1457721854
Name:HUTTON, JESSICA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:HUTTON
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 1:3000 BLACKBURN ST STE 130
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2217
Mailing Address - Country:US
Mailing Address - Phone:214-599-8624
Mailing Address - Fax:214-599-9156
Practice Address - Street 1:3000 BLACKBURN ST STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2217
Practice Address - Country:US
Practice Address - Phone:214-599-8624
Practice Address - Fax:214-559-9156
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9108924363AM0700X
TXPA11840363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical