Provider Demographics
NPI:1972811818
Name:ACUFF, JESSICA D (MSN, NP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:ACUFF
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:D
Other - Last Name:FENTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:1441 S MIDLOTHIAN PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5591
Mailing Address - Country:US
Mailing Address - Phone:972-723-1474
Mailing Address - Fax:972-723-9423
Practice Address - Street 1:1441 S MIDLOTHIAN PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5591
Practice Address - Country:US
Practice Address - Phone:972-723-1474
Practice Address - Fax:972-723-9423
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX730606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217359301Medicaid
TX217359301Medicaid
TXTXB113232Medicare PIN