Provider Demographics
NPI:1639452931
Name:BJERK, JESSICA ANNE (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:BJERK
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11212 HIGHWAY 151
Mailing Address - Street 2:BLDG 2 STE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4498
Mailing Address - Country:US
Mailing Address - Phone:210-520-7000
Mailing Address - Fax:210-520-7005
Practice Address - Street 1:11212 HIGHWAY 151
Practice Address - Street 2:BLDG 2 STE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4498
Practice Address - Country:US
Practice Address - Phone:210-520-7000
Practice Address - Fax:210-520-7005
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2015-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX699980363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N0011OtherBCBSTX
TX289879302Medicaid
TX289879302Medicaid
TXB145552Medicare PIN