Provider Demographics
NPI:1730685926
Name:BEARDSLEY, JESSICA MARIE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:BEARDSLEY
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 1:6701 FANNIN ST STE 1280
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2613
Mailing Address - Country:US
Mailing Address - Phone:832-826-6106
Mailing Address - Fax:832-825-8978
Practice Address - Street 1:6701 FANNIN ST STE 1280
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2613
Practice Address - Country:US
Practice Address - Phone:832-826-6106
Practice Address - Fax:832-825-8978
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV17382081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine