Provider Demographics
NPI:1063995009
Name:KAROL, JESSICA TRACY (LVN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:TRACY
Last Name:KAROL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S BLUE JAY CT
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76088-3878
Mailing Address - Country:US
Mailing Address - Phone:904-254-9230
Mailing Address - Fax:
Practice Address - Street 1:300 S BLUE JAY CT
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76088-3878
Practice Address - Country:US
Practice Address - Phone:904-254-9230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341217164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse