Provider Demographics
NPI:1528740677
Name:MCCARTY, JESSICA RENEE (YOGA THERAPIST)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:YOGA THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CAROL LN
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-9700
Mailing Address - Country:US
Mailing Address - Phone:210-860-3493
Mailing Address - Fax:
Practice Address - Street 1:200 E BROAD ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5904
Practice Address - Country:US
Practice Address - Phone:210-860-3493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171400000XOther Service ProvidersHealth & Wellness Coach