Provider Demographics
NPI:1669823787
Name:FARIAS, JESSICA (324090)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:FARIAS
Suffix:
Gender:F
Credentials:324090
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 N CAGE BLVD STE P
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1813
Mailing Address - Country:US
Mailing Address - Phone:956-787-3544
Mailing Address - Fax:
Practice Address - Street 1:5510 N CAGE BLVD STE P
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-1813
Practice Address - Country:US
Practice Address - Phone:956-787-3544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324090164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse