Provider Demographics
NPI:1306966353
Name:WALLING, JESSICA HEARD (APRN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:HEARD
Last Name:WALLING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12303 RUSTIC MANOR CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1018
Mailing Address - Country:US
Mailing Address - Phone:318-355-3334
Mailing Address - Fax:
Practice Address - Street 1:3500 W SLAUGHTER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-4421
Practice Address - Country:US
Practice Address - Phone:318-355-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2011-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX746393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K5846Medicare PIN