Provider Demographics
NPI:1376295220
Name:TRYON, JESSICA RENEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:TRYON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 BILLINGS RD
Mailing Address - Street 2:
Mailing Address - City:TOLAR
Mailing Address - State:TX
Mailing Address - Zip Code:76476-5423
Mailing Address - Country:US
Mailing Address - Phone:817-776-6115
Mailing Address - Fax:
Practice Address - Street 1:1305 PALUXY RD STE A
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5641
Practice Address - Country:US
Practice Address - Phone:817-573-6673
Practice Address - Fax:817-573-9783
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily