Provider Demographics
NPI:1780022731
Name:MEYERS, JESSICA (MPAP, PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MEYERS
Suffix:
Gender:F
Credentials:MPAP, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 NEALCREST CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2689
Mailing Address - Country:US
Mailing Address - Phone:858-354-4527
Mailing Address - Fax:
Practice Address - Street 1:651 S MOUNT JULIET RD # 1124
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-6319
Practice Address - Country:US
Practice Address - Phone:615-861-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22987363A00000X
AZ7733363A00000X
VA0110008415363A00000X
FLTPPA234363A00000X
MO2022039654363A00000X
NC0010-12860363A00000X
TNPA0000004858363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HL031ZOtherPTAN