Provider Demographics
NPI:1215302450
Name:SIBY, JESS (NP-C)
Entity type:Individual
Prefix:
First Name:JESS
Middle Name:
Last Name:SIBY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2689 MIRASOL LOOP
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2460
Mailing Address - Country:US
Mailing Address - Phone:512-743-6113
Mailing Address - Fax:
Practice Address - Street 1:4495 WANDERING VINE TRL
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1266
Practice Address - Country:US
Practice Address - Phone:832-797-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRX AUTH NUMBER:19445OtherTEXAS BOARD OF NURSING
TXAP129783OtherTEXAS BOARD OF NURSING