Healthcare Provider Details

I. General information

NPI: 1861050965
Provider Name (Legal Business Name): EMILIA JASPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 ALPHA DR STE 204
ROCKWALL TX
75087-4951
US

IV. Provider business mailing address

1975 ALPHA DR STE 204
ROCKWALL TX
75087-4951
US

V. Phone/Fax

Practice location:
  • Phone: 469-800-2100
  • Fax: 469-800-3310
Mailing address:
  • Phone: 469-800-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142606
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP142606
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: