Provider Demographics
NPI:1427242098
Name:CORPUS, JESUS E (EMT-LP, RN, MSN, FNP)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:E
Last Name:CORPUS
Suffix:
Gender:M
Credentials:EMT-LP, RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 S FLAG ST
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-9542
Mailing Address - Country:US
Mailing Address - Phone:956-478-5914
Mailing Address - Fax:
Practice Address - Street 1:2902 S FLAG ST
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-9542
Practice Address - Country:US
Practice Address - Phone:956-478-5914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101895146L00000X
TX799100163W00000X
TXAP141263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No163W00000XNursing Service ProvidersRegistered Nurse