Provider Demographics
NPI:1326828948
Name:PADDOCK, JESSICA (CSFA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E WHITESTONE BLVD UNIT 1057
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78630-4344
Mailing Address - Country:US
Mailing Address - Phone:512-271-9723
Mailing Address - Fax:
Practice Address - Street 1:500 E WHITESTONE BLVD UNIT 1057
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78630-4344
Practice Address - Country:US
Practice Address - Phone:512-271-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty