Provider Demographics
NPI:1750377677
Name:MORELAND, JESSICA GERMOND (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:GERMOND
Last Name:MORELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:GERMOND
Other - Last Name:KLEKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-456-1600
Mailing Address - Fax:214-456-7594
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-456-1600
Practice Address - Fax:214-456-7594
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA325712080P0203X
TXP86052080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0180000Medicaid
IA46030OtherWELLMARK BCBS
IA0180000Medicaid
G82168Medicare UPIN