Provider Demographics
NPI:1588901896
Name:HOLLEY, JESSICA LEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:WENDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7011 RIBELIN RANCH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8585
Mailing Address - Country:US
Mailing Address - Phone:512-345-7436
Mailing Address - Fax:512-346-7436
Practice Address - Street 1:7011 RIBELIN RANCH RD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8585
Practice Address - Country:US
Practice Address - Phone:512-345-7436
Practice Address - Fax:512-346-7436
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08267363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX321451201Medicaid
TX321451202Medicaid
TX321451202Medicaid
TX291561YL9JMedicare PIN