MEDICARE: JESSICA NICOLE CASEY PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1057206	TX

General Provider Information

NPI Number	:	1518730167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA NICOLE CASEY PMHNP-BC

Provider Business Mailing Address
First Line	:	8207 CALLAGHAN RD STE 200
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-4736
Country	:	US
Telephone Number	:	210-646-1570
Fax Number	:	800-685-0233

Provider Business Practice Location Address
First Line	:	8207 CALLAGHAN RD STE 200
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-4736
Country	:	US
Telephone Number	:	210-646-1570
Fax Number	:	800-685-0233

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	12/16/2025

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