Provider Demographics
NPI:1518325638
Name:FARRELL, JESSICA CATHERINE (NP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CATHERINE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:CATHERINE
Other - Last Name:HATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:6620 MAIN ST
Mailing Address - Street 2:SUITE 11A.04.6
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2348
Mailing Address - Country:US
Mailing Address - Phone:713-798-2400
Mailing Address - Fax:713-798-7337
Practice Address - Street 1:6620 MAIN ST
Practice Address - Street 2:SUITE 11A.04.6
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2348
Practice Address - Country:US
Practice Address - Phone:713-798-2400
Practice Address - Fax:713-798-7337
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX353825804Medicaid
TX482585YVBOMedicare UPIN