Provider Demographics
NPI: | 1013456649 |
---|---|
Name: | JASSO, GYPSY JANE (MSN, APRN, FNP-C) |
Entity type: | Individual |
Prefix: | |
First Name: | GYPSY |
Middle Name: | JANE |
Last Name: | JASSO |
Suffix: | |
Gender: | F |
Credentials: | MSN, APRN, 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: | 4214 ANDREWS HWY STE 240 |
Mailing Address - Street 2: | |
Mailing Address - City: | MIDLAND |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 79703-4817 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 432-686-6605 |
Mailing Address - Fax: | 432-682-2284 |
Practice Address - Street 1: | 400 ROSALIND REDFERN GROVER PKWY |
Practice Address - Street 2: | |
Practice Address - City: | MIDLAND |
Practice Address - State: | TX |
Practice Address - Zip Code: | 79701-5846 |
Practice Address - Country: | US |
Practice Address - Phone: | 432-221-1111 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2017-02-15 |
Last Update Date: | 2025-08-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | AP133109 | 363L00000X, 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 372790101 | Medicaid |