Provider Demographics
NPI:1487987574
Name:SHULTZ, JESSICA BRIE (PNP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BRIE
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:BRIE
Other - Last Name:VAN BYSSUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 S. 31ST STREET
Practice Address - Street 2:SCOTT & WHITE MEMORIAL HOSPITAL ORTHOPEDICS DEPT.
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508
Practice Address - Country:US
Practice Address - Phone:254-724-6262
Practice Address - Fax:254-724-7791
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX772556363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMV2052897OtherDEA