Provider Demographics
NPI:1801350525
Name:HAVIR, JESSICA DAWN (FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:HAVIR
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 1:2957 S FM 2869
Mailing Address - Street 2:
Mailing Address - City:HAWKINS
Mailing Address - State:TX
Mailing Address - Zip Code:75765-4730
Mailing Address - Country:US
Mailing Address - Phone:865-680-3867
Mailing Address - Fax:
Practice Address - Street 1:5321 S FM 14
Practice Address - Street 2:
Practice Address - City:HAWKINS
Practice Address - State:TX
Practice Address - Zip Code:75765-4839
Practice Address - Country:US
Practice Address - Phone:903-769-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-27
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily