Provider Demographics
NPI:1265848121
Name:EDWARDS, JESSICA I (DO)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:I
Last Name:EDWARDS
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 S MOPAC EXPY STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5883
Mailing Address - Country:US
Mailing Address - Phone:512-491-3702
Mailing Address - Fax:512-641-6150
Practice Address - Street 1:901 S MOPAC EXPY STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5883
Practice Address - Country:US
Practice Address - Phone:512-491-3702
Practice Address - Fax:512-641-6150
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4689207Q00000X
CA20A23224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A23224OtherOSTEOPATHIC MEDICAL BOARD OF CALIFORNIA