| Doctor Name: | JESSICA A RADLEY |
| NPI Number: | 1003057829 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | 677695 |
| Business Practice Address: | 109 Shult Dr Columbus, TX - 789343009 |
| Business Phone Number: | 9797325794 |
| Business Fax Number: | 9797325795 |
| Mailing Address: | 109 Shult Dr, COLUMBUS |
| State: | TX |
| Postal Code: | 789343009 |
| Phone Number: | 9797325794 |
| Fax Number: | |
| NPI Enumeration Date: | 03/09/2009 |
| NPI Last Update Date: | 04/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 677695 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |