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Individual

MISS JESSICA LANE PACKARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
10111 ROSEBERRY DR, LA PORTE, TX 77571-2914
(210) 660-9976
Mailing address
10111 ROSEBERRY DR, LA PORTE, TX 77571-2914
(210) 660-9976

Taxonomy

Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
363AS0400X
Surgical Physician Assistant
Primary

Other

Enumeration date
06/10/2022
Last updated
06/28/2022
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