Provider Demographics
NPI:1386072387
Name:CROSS, JEAN CAROLYN
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:CAROLYN
Last Name:CROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:CAROLYN
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:17755 BOSSE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:77880-6501
Mailing Address - Country:US
Mailing Address - Phone:281-455-7127
Mailing Address - Fax:
Practice Address - Street 1:110 HIGHWAY 290 W
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-9165
Practice Address - Country:US
Practice Address - Phone:979-277-7125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily