Provider Demographics
| NPI: | 1013456649 |
|---|---|
| Name: | JASSO, GYPSY JANE (MSN, APRN, FNP-C) |
| Entity type: | Individual |
| Prefix: | |
| First Name: | GYPSY |
| Middle Name: | JANE |
| Last Name: | JASSO |
| Suffix: | |
| Gender: | F |
| Credentials: | MSN, APRN, FNP-C |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 4214 ANDREWS HWY STE 240 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MIDLAND |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 79703-4817 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 432-686-6605 |
| Mailing Address - Fax: | 432-682-2284 |
| Practice Address - Street 1: | 400 ROSALIND REDFERN GROVER PKWY |
| Practice Address - Street 2: | |
| Practice Address - City: | MIDLAND |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 79701-5846 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 432-221-1111 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2017-02-15 |
| Last Update Date: | 2025-08-06 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| TX | AP133109 | 363L00000X, 363LF0000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 372790101 | Medicaid |