Healthcare Provider Details

I. General information

NPI: 1285542407
Provider Name (Legal Business Name): JESSICA EUDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W STOREY ST
SAN SABA TX
76877-5710
US

IV. Provider business mailing address

408 W STOREY ST
SAN SABA TX
76877-5710
US

V. Phone/Fax

Practice location:
  • Phone: 806-654-2305
  • Fax:
Mailing address:
  • Phone: 806-654-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99649
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: