Provider Demographics
NPI:1306198270
Name:SALAS, JESSICA NICOLE (CPNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:SALAS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 N MIDKIFF RD STE D4
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-4249
Mailing Address - Country:US
Mailing Address - Phone:432-218-8899
Mailing Address - Fax:432-624-8355
Practice Address - Street 1:4410 N MIDKIFF RD STE D4
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-4249
Practice Address - Country:US
Practice Address - Phone:432-218-8899
Practice Address - Fax:432-264-8355
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122496363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics