Individual
TIMOTHY A JESSIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
207 N TOWNLINE RD STE 101, LAGRANGE, IN 46761-1325
(260) 463-9335
(260) 463-9334
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01076415A
IN
208600000X
Surgery Physician
200501327
NC
208600000X
Surgery Physician
32580
KS
208600000X
Surgery Physician
35083403
OH
208600000X
Surgery Physician
D73747
MD
208600000X
Surgery Physician
MD2020-0191
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24-46612
UHC
OH
05
—
2501902
—
OH
05
—
69777233
—
NM
01
—
P00144471
RRMC
OH
Enumeration date
07/28/2005
Last updated
05/02/2025
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