Provider Demographics
NPI:1033936281
Name:MOBLEY, JETTA KAY
Entity type:Individual
Prefix:
First Name:JETTA
Middle Name:KAY
Last Name:MOBLEY
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 1:622 CHRIS THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77905-3399
Mailing Address - Country:US
Mailing Address - Phone:361-218-7102
Mailing Address - Fax:
Practice Address - Street 1:622 CHRIS THOMPSON RD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77905-3399
Practice Address - Country:US
Practice Address - Phone:361-218-7102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor