Provider Demographics
NPI:1487520078
Name:TRAN, JESSIE (PA)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 W RANDOL MILL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-6509
Mailing Address - Country:US
Mailing Address - Phone:817-860-2700
Mailing Address - Fax:817-860-2704
Practice Address - Street 1:1119 W RANDOL MILL RD STE 110
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-6509
Practice Address - Country:US
Practice Address - Phone:817-860-2700
Practice Address - Fax:817-860-2704
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant