Individual
MRS. JESSICA DENISE MODISETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
707 E MARSHALL AVE, LONGVIEW, TX 75601-5545
(903) 315-5400
Mailing address
707 E MARSHALL AVE, LONGVIEW, TX 75601-5545
(903) 315-5400
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
833036
TX
363L00000X
Nurse Practitioner
1073260
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
1073260
TX
Other
Enumeration date
03/18/2022
Last updated
05/05/2022
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