MEDICARE: JESSICA MARIE MONTEMAYOR CPNP

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	363LP0200X	Pediatric Nurse Practitioner	1031070	TX

General Provider Information

NPI Number	:	1750037255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIE MONTEMAYOR CPNP

Provider Business Mailing Address
First Line	:	633 S SAINT MARYS ST UNIT 1409
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-3518
Country	:	US
Telephone Number	:	210-827-7426
Fax Number	:

Provider Business Practice Location Address
First Line	:	2316 SE MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-3527
Country	:	US
Telephone Number	:	210-817-7004
Fax Number	:

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

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	02/23/2022

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