Provider Demographics
NPI:1174112957
Name:HYDE, JESSICA KATHRYN (RN, BSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATHRYN
Last Name:HYDE
Suffix:
Gender:F
Credentials:RN, BSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500A HOWELLWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5954
Mailing Address - Country:US
Mailing Address - Phone:512-299-3626
Mailing Address - Fax:
Practice Address - Street 1:2500A HOWELLWOOD WAY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5954
Practice Address - Country:US
Practice Address - Phone:512-299-3626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1020421363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health