Individual
JESSIE BATHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 250-2330
Mailing address
7012 FLAMENCIA, GRAND PRAIRIE, TX 75054-5560
(817) 714-6327
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
615680
TX
Other
Enumeration date
03/25/2020
Last updated
03/25/2020
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