Provider Demographics
NPI:1720663602
Name:GATLIN, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GATLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12777 FM 699
Mailing Address - Street 2:
Mailing Address - City:JOAQUIN
Mailing Address - State:TX
Mailing Address - Zip Code:75954-2199
Mailing Address - Country:US
Mailing Address - Phone:936-248-4225
Mailing Address - Fax:
Practice Address - Street 1:507 JACOB ST
Practice Address - Street 2:
Practice Address - City:TIMPSON
Practice Address - State:TX
Practice Address - Zip Code:75975-5255
Practice Address - Country:US
Practice Address - Phone:936-254-3338
Practice Address - Fax:936-254-3339
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1002858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty