Provider Demographics
NPI:1154105138
Name:DUDLEY, JESSICA NICOLE (WHNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9535 WILLARD DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3898
Mailing Address - Country:US
Mailing Address - Phone:601-329-9313
Mailing Address - Fax:
Practice Address - Street 1:4600 GULF FWY STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3533
Practice Address - Country:US
Practice Address - Phone:713-522-3976
Practice Address - Fax:404-494-7435
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115266363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health