Healthcare Provider Details

I. General information

NPI: 1629400890
Provider Name (Legal Business Name): JESSICA J YOUNG P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA JO GIBBS

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 PINE ST
ABILENE TX
79601-2432
US

IV. Provider business mailing address

PO BOX 5210
NORMAN OK
73070-5210
US

V. Phone/Fax

Practice location:
  • Phone: 325-670-2151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: