Healthcare Provider Details

I. General information

NPI: 1174453971
Provider Name (Legal Business Name): JESSICA ABIGAIL CRISANTO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 BRIARCREST DR
BRYAN TX
77802-2763
US

IV. Provider business mailing address

208 DALE ST
DIBOLL TX
75941-2113
US

V. Phone/Fax

Practice location:
  • Phone: 713-933-8590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1137284
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: