Individual
JESSICA WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4611 GUADALUPE ST STE 200, AUSTIN, TX 78751-2928
(512) 476-2830
(512) 476-2832
Mailing address
17510 DELL CITY DR, ROUND ROCK, TX 78664-7255
(979) 204-1742
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
TX
Other
Enumeration date
04/18/2014
Last updated
08/11/2021
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