Healthcare Provider Details

I. General information

NPI: 1790389039
Provider Name (Legal Business Name): JESSICA LYNN CRESPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15551 SOUTHWEST FWY
SUGAR LAND TX
77478-3830
US

IV. Provider business mailing address

9734 SABLE CANYON DR
RICHMOND TX
77406-1635
US

V. Phone/Fax

Practice location:
  • Phone: 281-325-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1013846
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1013648
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: