Provider Demographics
NPI:1487369419
Name:MAHONEY COOMBS, JESSICA ORLENE (FNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ORLENE
Last Name:MAHONEY COOMBS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7104 CHAMBERS CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4018
Mailing Address - Country:US
Mailing Address - Phone:817-675-6174
Mailing Address - Fax:
Practice Address - Street 1:7104 CHAMBERS CREEK LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4018
Practice Address - Country:US
Practice Address - Phone:817-675-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1061358363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty