Provider Demographics
NPI:1871151324
Name:MEHRARA, JESSICA SOUVATDY (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SOUVATDY
Last Name:MEHRARA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 E BAYAUD AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-3836
Mailing Address - Country:US
Mailing Address - Phone:479-719-9215
Mailing Address - Fax:
Practice Address - Street 1:1920 N HIGH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1213
Practice Address - Country:US
Practice Address - Phone:303-320-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR102434163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse