Individual
JESSE ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4201 BARTLETT ST, HOMER, AK 99603-7015
(907) 235-7000
Mailing address
16951 E QUINCY AVE, AURORA, CO 80015-1901
(303) 752-5480
(303) 752-5481
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
115396
AK
363A00000X
Physician Assistant
Primary
PA.0007001
CO
Other
Enumeration date
12/10/2014
Last updated
04/23/2026
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