Provider Demographics
NPI:1538636444
Name:WHITIS, JESSICA LEE (MSN APRN AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:WHITIS
Suffix:
Gender:F
Credentials:MSN APRN AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 WATERMARK LN
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-6419
Mailing Address - Country:US
Mailing Address - Phone:972-965-2501
Mailing Address - Fax:
Practice Address - Street 1:1600 COIT RD STE 104
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6171
Practice Address - Country:US
Practice Address - Phone:972-566-5411
Practice Address - Fax:972-519-8337
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139538363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care