Provider Demographics
NPI:1194052779
Name:ZAITCHIK, JESSE R (CPNP)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:R
Last Name:ZAITCHIK
Suffix:
Gender:M
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 W. SPRING CREEK PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4236
Mailing Address - Country:US
Mailing Address - Phone:214-918-3340
Mailing Address - Fax:972-767-3363
Practice Address - Street 1:6520 N PRESIDENT GEORGE BUSH HWY STE 100
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-3925
Practice Address - Country:US
Practice Address - Phone:972-532-9967
Practice Address - Fax:210-314-5044
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118181363LP0200X
NM76657363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics