Provider Demographics
NPI:1629398557
Name:GERHART, JESSICA LYNNE (DC, FNP, RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:GERHART
Suffix:
Gender:F
Credentials:DC, FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1638 BRIGHTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-1540
Mailing Address - Country:US
Mailing Address - Phone:972-689-3711
Mailing Address - Fax:
Practice Address - Street 1:122 W JOHN CARPENTER FWY STE 105
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2024
Practice Address - Country:US
Practice Address - Phone:972-378-0383
Practice Address - Fax:972-403-3434
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11347111N00000X
TX825592163W00000X
TX1143363AS0400X
TXAP127998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
No163W00000XNursing Service ProvidersRegistered Nurse
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherTIN
TX752747474OtherTIN