Provider Demographics
NPI:1982071007
Name:STEWART, JESSICA FOX (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FOX
Last Name:STEWART
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4435 RONALD REAGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-6566
Mailing Address - Country:US
Mailing Address - Phone:970-619-8139
Mailing Address - Fax:
Practice Address - Street 1:4435 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-6566
Practice Address - Country:US
Practice Address - Phone:970-619-8139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005371363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant