Healthcare Provider Details

I. General information

NPI: 1508280868
Provider Name (Legal Business Name): JESSICA MOUA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 E HARDING WAY
STOCKTON CA
95204-6110
US

IV. Provider business mailing address

582 E HARDING WAY
STOCKTON CA
95204-6110
US

V. Phone/Fax

Practice location:
  • Phone: 888-530-4415
  • Fax: 844-226-9193
Mailing address:
  • Phone: 888-530-4415
  • Fax: 844-226-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5776-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number174942-30
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: