Provider Demographics
NPI:1144974361
Name:DE LEON, JESSICA LEE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:DE LEON
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5056
Mailing Address - Country:US
Mailing Address - Phone:956-686-0574
Mailing Address - Fax:956-686-3301
Practice Address - Street 1:801 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5056
Practice Address - Country:US
Practice Address - Phone:956-686-0574
Practice Address - Fax:956-686-3301
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145496363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology