Provider Demographics
NPI:1417496589
Name:MAULDIN, JESSICA MEENOO (FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MEENOO
Last Name:MAULDIN
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 1:5840 E 2ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4363
Mailing Address - Country:US
Mailing Address - Phone:307-315-6133
Mailing Address - Fax:
Practice Address - Street 1:5840 E 2ND ST STE 200
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4363
Practice Address - Country:US
Practice Address - Phone:307-315-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY44423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP131862OtherTEXAS MEDICAL LICENSE