Individual
JESSICA HENDRIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085-005908
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085005908
STATE LICENSE
IL
Enumeration date
11/05/2015
Last updated
06/22/2018
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