# JESSICA PROCHNOW, RNFA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437400942
- **Authorized official:** MR. SAM WORTH (BILLING MANAGER)
- **Authorized official phone:** (214) 227-2457

## Contact information

- **Practice address:** 2903 HYDER AVE SE, ALBUQUERQUE, NM 87106-2938
- **Practice address phone:** (214) 227-2457
- **Practice address fax:** (972) 463-7247
- **Mailing address:** 2903 HYDER AVE SE, ALBUQUERQUE, NM 87106-2938
- **Mailing address phone:** (214) 227-2457
- **Mailing address fax:** (972) 463-7247

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | R49466 | NM | Yes |

## Other

- **Enumeration date:** 09/24/2012
- **Last updated:** 09/24/2012