Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99259 | TX |
NPI | 1124683792 |
---|---|
Provider Name | Jessica Ann Gregory |
First Address | San Antonio, TX 78254-1747 |
Second Address | San Antonio, TX 78254-1747 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2019 |
Last Update Date | 08/05/2019 |