Provider Demographics
NPI:1780199976
Name:CAIN, JESSICA N
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:N
Last Name:CAIN
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 1:4747 WILLIAMS DR STE 334
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-2017
Mailing Address - Country:US
Mailing Address - Phone:512-826-2527
Mailing Address - Fax:
Practice Address - Street 1:4747 WILLIAMS DR STE 334
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-2017
Practice Address - Country:US
Practice Address - Phone:512-826-2527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-10
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14525174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist