Provider Demographics
NPI:1306377148
Name:GUTIERREZ, JESSICA (APRN, FNP-C, CCM)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:APRN, FNP-C, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1284 PAREDES LINE ROAD
Mailing Address - Street 2:OFFICE C
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-1731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1284 PAREDES LINE ROAD
Practice Address - Street 2:OFFICE C
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-1731
Practice Address - Country:US
Practice Address - Phone:569-597-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133056363LF0000X, 363LP2300X, 171M00000X
MN8184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX564472YLPSOtherWELLMED PTAN