Individual
JESSICA ANN ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
900 W MAGNOLIA AVE STE 100, FORT WORTH, TX 76104-8518
(817) 870-7300
(817) 332-5117
Mailing address
PO BOX 206239, DALLAS, TX 75320-6239
(214) 424-2200
(469) 547-5339
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP138318
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP138318
NURSE PRACTIONER
TX
Enumeration date
12/06/2018
Last updated
04/27/2021
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