Individual
MRS. JACQUELINE ALLEN JESSIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
9900 BREN RD E, MINNETONKA, MN 55343-9664
(478) 538-0908
Mailing address
8499 KARLSTAD CV, CORDOVA, TN 38018-7384
(281) 248-1383
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
647853
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8F21691
MEDICARE IDENTIFICATION NUMBER
TX
Enumeration date
09/08/2008
Last updated
06/27/2020
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