Provider Demographics
NPI:1023365087
Name:CHRISTIAN, JESSICA NICOLE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:NICOLE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:NICOLE
Other - Last Name:STRUBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:319 HIGHWAY 36 BYP S STE 401
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-2741
Practice Address - Country:US
Practice Address - Phone:254-248-6500
Practice Address - Fax:254-248-6594
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07938363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314752YKPWMedicare PIN