Provider Demographics
NPI:1447392303
Name:MERTINS, MARY JESSICA (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JESSICA
Last Name:MERTINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W. 15TH STREET
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045
Mailing Address - Country:US
Mailing Address - Phone:806-364-7512
Mailing Address - Fax:806-364-5256
Practice Address - Street 1:540 W. 15TH STREET
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045
Practice Address - Country:US
Practice Address - Phone:806-364-7512
Practice Address - Fax:806-364-5256
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX617852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX617852OtherRN LICENSE NUMBER
TX06710OtherPRESCRIPTION ID NUMBER