Healthcare Provider Details

I. General information

NPI: 1497372288
Provider Name (Legal Business Name): JESSIE LORRAINE SOUTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSIE LORRAINE BOYD

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HILLRISE CIR
LAS CRUCES NM
88011-4741
US

IV. Provider business mailing address

9010 SHEARER ST
ROWLETT TX
75088-4445
US

V. Phone/Fax

Practice location:
  • Phone: 720-966-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3450
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: