Provider Demographics
NPI:1962166504
Name:HERNANDEZ, JESSICA L (PA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-497-5355
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:2515 DESALES AVE STE 206
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1100
Practice Address - Country:US
Practice Address - Phone:423-698-8101
Practice Address - Fax:423-698-3450
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA10698363A00000X
TN4772363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant