Basic Information
| Provider Information | |||||||||
| NPI: | 1326386145 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 FANNIN ST | ||||||||
| Address2: | SUITE 2070 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137046731 | ||||||||
| FaxNumber: | 7137041796 | ||||||||
| Practice Location | |||||||||
| Address1: | 4141 VISTA RD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775042113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139473100 | ||||||||
| FaxNumber: | 7139476103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2013 | ||||||||
| LastUpdateDate: | 02/02/2016 | ||||||||
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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 | 363A00000X | PA08088 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0035TD | 01 | TX | BCBSTX GRP RECORD NUMBER | OTHER | DB6392 | 01 | TX | GRP RAILROAD MDCR PTAN | OTHER | 153449704 | 01 | TX | HARRIS COUNTY GRP TPI | OTHER | 302679101 | 01 | TX | BRAZORIA COUNTY GRP TPI | OTHER | 00106W | 01 | TX | HARRIS COUNTY GRP MDCR PTAN | OTHER | 00X185 | 01 | TX | BRAZORIA COUNTY GRP PTAN | OTHER | 274019YNBT | 01 | TX | MEDICARE PTAN FOR HARRIS CO | OTHER | 274019YPXV | 01 | TX | MEDICARE PTAN FOR BRAZORIA CO | OTHER |