MEDICARE: JESSICA COLLEEN WESLEY CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	AP123965	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306220181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA COLLEEN WESLEY CPNP

Provider Business Mailing Address
First Line	:	1464 E WHITESTONE BLVD STE 2104
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-9079
Country	:	US
Telephone Number	:	512-260-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1464 E WHITESTONE BLVD STE 2104
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-9079
Country	:	US
Telephone Number	:	512-260-8100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2015
Last Update Date	:	02/13/2023

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