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Individual

JESSICA LOUISE LICEA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
510 N HEWITT DR, HEWITT, TX 76643-3038
(254) 420-5000
(254) 420-5007
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA18063
TX

Other

Enumeration date
02/29/2024
Last updated
10/23/2024
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