Provider Demographics
NPI:1386170827
Name:GORETSKIE, JESSICA (RSA, CSA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GORETSKIE
Suffix:
Gender:F
Credentials:RSA, CSA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RAE
Other - Last Name:PFEIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:588 COUNTY ROAD L
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:TX
Mailing Address - Zip Code:79381-1500
Mailing Address - Country:US
Mailing Address - Phone:815-823-9067
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 96283
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-0128
Practice Address - Country:US
Practice Address - Phone:972-978-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2025-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000542246ZC0007X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant