Provider Demographics
NPI:1871240721
Name:PRITCHETT, JESSE (PMHNP)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:PRITCHETT
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E OVILLA RD
Mailing Address - Street 2:STE 1A #162
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154
Mailing Address - Country:US
Mailing Address - Phone:469-383-8795
Mailing Address - Fax:469-242-9679
Practice Address - Street 1:106 E OVILLA RD
Practice Address - Street 2:STE 1A #162
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154
Practice Address - Country:US
Practice Address - Phone:469-383-8795
Practice Address - Fax:469-242-9679
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1071648363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health