Individual
JESSICA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1575 N DYSART RD, AVONDALE, AZ 85392-1204
(236) 879-8836
(623) 687-9884
Mailing address
11956 W CHASE LN, AVONDALE, AZ 85323-7709
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5722
AZ
Other
Enumeration date
06/23/2014
Last updated
04/23/2025
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