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General NPI Number Information
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NPI Number | 1447126644
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Entity Type | Individual
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Provider Name | JESSICA NIELSEN
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Gender | Female
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 7914 MARTINELLI
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City | SAN ANTONIO
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State | TX
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Zip | 78253-5042
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Country | US
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Telephone | 843-441-2077
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Fax |
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Provider Business Mailing Address
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Address Line | 9110 N LOOP 1604 W STE 104 PMB 3004
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City | SAN ANTONIO
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State | TX
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Zip | 78249-3397
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Country | US
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Telephone | 843-441-2077
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 161690
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License Number State | TX
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