Basic Information
| Provider Information | |||||||||
| NPI: | 1194052779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAITCHIK | ||||||||
| FirstName: | JESSE | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5655 W. SPRING CREEK PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750244236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149183340 | ||||||||
| FaxNumber: | 9727673363 | ||||||||
| Practice Location | |||||||||
| Address1: | 6520 N PRESIDENT GEORGE BUSH HWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750443925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725329967 | ||||||||
| FaxNumber: | 2103145044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2009 | ||||||||
| LastUpdateDate: | 07/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | AP118181 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.