Healthcare Provider Details

I. General information

NPI: 1326344854
Provider Name (Legal Business Name): JESSICA LEIGH CROSS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA P WILLIAMS FNP-BC

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 07/14/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E MAIN STREET
RED RIVER NM
87558-0010
US

IV. Provider business mailing address

PO BOX 10
RED RIVER NM
87558-0010
US

V. Phone/Fax

Practice location:
  • Phone: 575-754-6330
  • Fax: 575-754-7168
Mailing address:
  • Phone: 575-754-6330
  • Fax: 575-222-1292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number712751
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01822
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: