Provider Demographics
NPI:1720158595
Name:WILSON, JESSICA PLICHTA (MS, APRN-PMH)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:PLICHTA
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, APRN-PMH
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ERIN
Other - Last Name:PLICHTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:10235 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-4454
Mailing Address - Country:US
Mailing Address - Phone:361-937-1010
Mailing Address - Fax:361-937-1296
Practice Address - Street 1:10235 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-4454
Practice Address - Country:US
Practice Address - Phone:361-937-1010
Practice Address - Fax:361-937-1296
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX735117363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB144721OtherMEDICARE PTAN
TX00NP7501OtherBC/BS-TX
TX208391703Medicaid