Provider Demographics
NPI:1982076956
Name:FERRELL, JESSICA NICOLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:NICOLE
Last Name:FERRELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9200 PINECROFT DR STE 350
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3280
Mailing Address - Country:US
Mailing Address - Phone:346-320-5200
Mailing Address - Fax:346-320-5215
Practice Address - Street 1:9200 PINECROFT DR STE 350
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3280
Practice Address - Country:US
Practice Address - Phone:346-320-5200
Practice Address - Fax:346-320-5215
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
TXPA10248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8329NTOtherBCBS - USA
TX8330NTOtherBCBS - USP
TXPA10248OtherPA LICENCE