Basic Information
| Provider Information | |||||||||
| NPI: | 1932538220 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHAN | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | HELEN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 TUSKEGEE BLVD | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199025003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026776865 | ||||||||
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| Practice Location | |||||||||
| Address1: | RAF LAKENHEATH 48 MDG/SGHC | ||||||||
| Address2: | UNIT 5115 | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 094615115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1638528124 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2013 | ||||||||
| LastUpdateDate: | 05/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP07474 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.