Provider Demographics
NPI:1336945948
Name:OPELA, JESSE
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:OPELA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SAINT JOSEPH CT STE 320
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-3404
Mailing Address - Country:US
Mailing Address - Phone:512-277-0676
Mailing Address - Fax:737-250-7650
Practice Address - Street 1:201 SAINT JOSEPH CT STE 320
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-3404
Practice Address - Country:US
Practice Address - Phone:512-277-0676
Practice Address - Fax:737-250-7650
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX985320363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health