Provider Demographics
NPI:1770613838
Name:MOORE-SCHEELER, JESSICA ELAINE (PA-C)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ELAINE
Last Name:MOORE-SCHEELER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ELAINE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4743 ARAPAHOE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1123
Mailing Address - Country:US
Mailing Address - Phone:303-449-3642
Mailing Address - Fax:303-440-7299
Practice Address - Street 1:4743 ARAPAHOE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1123
Practice Address - Country:US
Practice Address - Phone:303-449-3642
Practice Address - Fax:303-440-7299
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103710363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972561439Medicaid
VA1972561439Medicaid
VA00X928C09Medicare PIN