Provider Demographics
NPI:1942520275
Name:ALEXANDER, JESSICA RACHEL (EMT-P, PA-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RACHEL
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:EMT-P, PA-C
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:RACHEL
Other - Last Name:RYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMT-P
Mailing Address - Street 1:1500 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4917
Mailing Address - Country:US
Mailing Address - Phone:819-702-8795
Mailing Address - Fax:
Practice Address - Street 1:1500 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4917
Practice Address - Country:US
Practice Address - Phone:819-702-8795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55713146L00000X
TXNA00188304376K00000X
TXPA06882363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No376K00000XNursing Service Related ProvidersNurse's Aide