Provider Demographics
NPI:1104587856
Name:PERALES, JESSICA LEIGH (APRN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEIGH
Last Name:PERALES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:LIVELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8811 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5415
Mailing Address - Country:US
Mailing Address - Phone:210-297-2000
Mailing Address - Fax:
Practice Address - Street 1:8811 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5415
Practice Address - Country:US
Practice Address - Phone:210-297-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154588363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner