Individual
MARY JESSICA FIESTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-BC
Contact information
Practice address
6301 GASTON AVE, SUITE 100 WEST TOWER, DALLAS, TX 75214-3922
(214) 827-3610
(214) 821-4017
Mailing address
906 W CANNON ST, STE A, FORT WORTH, TX 76104-3031
(817) 321-0951
(817) 299-0790
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
721121
TX
Other
Enumeration date
01/17/2013
Last updated
03/20/2020
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