Provider Demographics
NPI:1306331814
Name:DETTMAN, JESSICA BRIANNE (PA)
Entity type:Individual
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First Name:JESSICA
Middle Name:BRIANNE
Last Name:DETTMAN
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1023 W HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5002
Mailing Address - Country:US
Mailing Address - Phone:225-743-2366
Mailing Address - Fax:225-743-2369
Practice Address - Street 1:1023 W HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5002
Practice Address - Country:US
Practice Address - Phone:225-743-2366
Practice Address - Fax:225-743-2369
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2020-02-21
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant