Provider Demographics
NPI:1578991477
Name:CASTILLO, JESSICA (RN FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11538
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-1538
Mailing Address - Country:US
Mailing Address - Phone:325-670-4372
Mailing Address - Fax:325-670-4040
Practice Address - Street 1:4351 RIDGEMONT DR STE A
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8747
Practice Address - Country:US
Practice Address - Phone:254-245-9175
Practice Address - Fax:254-213-7771
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF1013198OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD