Provider Demographics
NPI:1093273575
Name:FARRIS, JESSICA ANN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:FARRIS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 DON MAYNARD ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-3132
Mailing Address - Country:US
Mailing Address - Phone:915-355-0608
Mailing Address - Fax:
Practice Address - Street 1:2430 MCRAE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-6020
Practice Address - Country:US
Practice Address - Phone:915-434-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT55172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer