Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP120603 | TX |
NPI | 1003100363 |
---|---|
Provider Name | Jessica M. Stephens |
First Address | San Antonio, TX 78221-3117 |
Second Address | San Antonio, TX 78229-4401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2011 |
Last Update Date | 10/12/2021 |