Provider Demographics
NPI:1982076956
Name:FERRELL, JESSICA NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:NICOLE
Last Name:FERRELL
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:2255 E MOSSY OAKS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1813
Mailing Address - Country:US
Mailing Address - Phone:832-232-5556
Mailing Address - Fax:281-298-3996
Practice Address - Street 1:8845 SIX PINES DR # 2
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-2675
Practice Address - Country:US
Practice Address - Phone:281-465-1746
Practice Address - Fax:281-465-3307
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA10248OtherPA LICENCE
TX8329NTOtherBCBS - USA
TX8330NTOtherBCBS - USP