Provider Demographics
NPI:1972314888
Name:KALIEL, JESSICA JOANN (AGACNP-BC)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:JOANN
Last Name:KALIEL
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6868 CATALPA BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-8127
Mailing Address - Country:US
Mailing Address - Phone:626-221-2886
Mailing Address - Fax:
Practice Address - Street 1:6868 CATALPA BLUFF LN
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-8127
Practice Address - Country:US
Practice Address - Phone:626-221-2886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1186215363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology