Provider Demographics
NPI:1861795700
Name:LINDEMOOD, JESSICA R (PA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:LINDEMOOD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 W 5TH ST STE 3142
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-4206
Mailing Address - Country:US
Mailing Address - Phone:432-703-5004
Mailing Address - Fax:432-335-1807
Practice Address - Street 1:301 N N ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6404
Practice Address - Country:US
Practice Address - Phone:432-620-5800
Practice Address - Fax:432-620-5873
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA07061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant