Provider Demographics
NPI:1295497402
Name:ALVARADO, JESSICA NOELLE (FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NOELLE
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4816 105TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-5762
Mailing Address - Country:US
Mailing Address - Phone:806-620-5019
Mailing Address - Fax:
Practice Address - Street 1:3405 22ND ST STE 300
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1348
Practice Address - Country:US
Practice Address - Phone:806-788-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1428846363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health