Healthcare Provider Details

I. General information

NPI: 1134831597
Provider Name (Legal Business Name): JESSICA SILVA COMPTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA COOPER

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 W MONARCHWOOD DR
NIXA MO
65714-7947
US

IV. Provider business mailing address

341 W MONARCHWOOD DR
NIXA MO
65714-7947
US

V. Phone/Fax

Practice location:
  • Phone: 480-435-5940
  • Fax:
Mailing address:
  • Phone: 480-435-5940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13202
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: