Provider Demographics
NPI:1326344854
Name:CROSS, JESSICA LEIGH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:CROSS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:P
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:RED RIVER
Mailing Address - State:NM
Mailing Address - Zip Code:87558-0010
Mailing Address - Country:US
Mailing Address - Phone:575-754-6330
Mailing Address - Fax:575-222-1292
Practice Address - Street 1:200 PIONEER ROAD
Practice Address - Street 2:ST A
Practice Address - City:RED RIVER
Practice Address - State:NM
Practice Address - Zip Code:87558-0010
Practice Address - Country:US
Practice Address - Phone:575-754-6330
Practice Address - Fax:575-754-7168
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01822363LF0000X
TX712751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39532054Medicaid