Provider Demographics
NPI:1528406154
Name:JERRILEA A HUBBLE
Entity Type:Organization
Organization Name:JERRILEA A HUBBLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JERRILEA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:214-793-3537
Mailing Address - Street 1:4038 COUNTY ROAD 392
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-8610
Mailing Address - Country:US
Mailing Address - Phone:214-793-3537
Mailing Address - Fax:888-329-6432
Practice Address - Street 1:4038 COUNTY ROAD 392
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-8610
Practice Address - Country:US
Practice Address - Phone:214-793-3537
Practice Address - Fax:888-329-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX752938163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty