Provider Demographics
NPI:1104046820
Name:HEALY, JESSICA A (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:HEALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3316 W 66TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2544
Mailing Address - Country:US
Mailing Address - Phone:952-303-8600
Mailing Address - Fax:952-920-8899
Practice Address - Street 1:3555 WILLOW LAKE BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55110-5131
Practice Address - Country:US
Practice Address - Phone:651-770-0110
Practice Address - Fax:651-770-0134
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48236207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN487468000Medicaid
MN487468000Medicaid