Provider Demographics
NPI:1487496766
Name:PRICE, JESSICA SOPHIA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SOPHIA
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:SOPHIA
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1018 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-7156
Mailing Address - Country:US
Mailing Address - Phone:956-778-4303
Mailing Address - Fax:
Practice Address - Street 1:1221 E 10TH ST STE 102F
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4282
Practice Address - Country:US
Practice Address - Phone:956-778-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX753213146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic