JESSICA BEARDEN DIETERT (NPI# 1548605769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548605769 |
| Entity Type | Individual |
| Full Name | JESSICA BEARDEN DIETERT |
| Other Name | JESSICA NICOLE BEARDEN |
| Credential | M.D. |
| Practice Address |
14008 Shadowglen Blvd Ste 200 Manor TX 78653-3406 |
| Mailing Address |
4419 Frontier Trl Ste 110 Austin TX 78745-1567 |
| Practice Telephone | 5124447208 |
| Mailing Telephone | 5124447208 |
| Mailing Fax Number | 5124442343 |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2020-11-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | R7710 | TX | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
R7710 | TX | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | 1548605769 | TX | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6655 Travis St, Suite 600, Houston, TX 770301312 | 7135008268 | 7135243432 |
| 1 Barnes Jewish Hospital Plz, Saint Louis, MO 631101003 | 3143625000 | |
| 4419 Frontier Trl Ste 110, Austin, TX 787451567 | 5124447208 | 5124442343 |
| 505 W Louis Henna Blvd Ste 200, Austin, TX 78728 | 5125339900 | 5125339901 |
| Street Address |
14008 SHADOWGLEN BLVD STE 200 |
| City | MANOR |
| State | TX |
| Zip Code | 78653-3406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588293112 | Angelica Marie Griffin | Residential Treatment Facility, Emotionally Disturbed Children | 12500 Shadowglen Trace 3204, Manor, TX 78653 | 2020-04-06 |
| 1215591391 | Manor Total Dental and Orthodontics Pllc | Durable Medical Equipment & Medical Supplies | 11828 Ring Dr. Ste 102, Manor, TX 78653 | 2019-04-24 |
| 1932698412 | New Hope Ranch | Substance Abuse Rehabilitation Facility | 11908 Sparks Road, Manor, TX 78653 | 2018-05-09 |
| 1649788332 | Adam Tyler Barnes, Dds of Texas II, Pllc | Dentist | 12700 Lexington Street, Suite 220, Manor, TX 78653 | 2018-01-16 |
| 1760998934 | Open Hearts & Open Doors Group Home Services, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11605 Mill Ridge Trce, Manor, TX 78653 | 2017-12-22 |
| 1184089443 | Manor Family Orthodontics, Pllc | Dentist | 11828 Ring Dr, Ste 102, Manor, TX 78653 | 2015-12-30 |
| 1225424542 | Rsvp Healthcare Alliance, LLC | Pharmacy | 14008 Shadow Glen Blvd, Ste 102, Manor, TX 78653 | 2015-04-14 |
| 1023410560 | Demitra Stephens Haynes | In Home Supportive Care | 18116 Flathead Dr, Manor, TX 78653 | 2014-09-16 |
| 1922429836 | Wal-mart Stores Texas LLC | Technician/Technologist | 11923 Us Hwy 290 E, Manor, TX 78653 | 2013-12-18 |
| 1710326434 | Lizania Montero | Dentist | 11300 Hwy 290 E, Suite 200, Manor, TX 78653 | 2013-06-15 |
| Find all providers in zip 78653 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649800848 | Skin Cancer Dermatology, Pllc | Dermatology | 3327 Research Plz Ste 414, San Antonio, TX 78235-5159 | 2020-01-16 |
| 1598302721 | Austin Skin Pllc | Dermatology | 1501 Dorothy Nichols Ln # B, Smithville, TX 78957-1725 | 2019-12-06 |
| 1154717726 | Joshua Lee Owen | Dermatology | 2632 Broadway, Suite 300 South, San Antonio, TX 78215-7821 | 2015-04-10 |
| 1043615263 | Epiphany Dermatology Pa | Dermatology | 7106 Sanger Avenue, Waco, TX 76712-3928 | 2014-10-30 |
| 1255745915 | Leon Chen | Dermatology | 6655 Travis St Ste 650, Houston, TX 77030-1316 | 2014-06-19 |
| 1750624391 | Houston Skin Cancer Associates, Pllc | Dermatology | 1401 Binz Street, Suite 200, Houston, TX 77004 | 2013-04-02 |
| 1457695413 | Oliver Street 5.01(a) Inc. | Dermatology | 5310 Harvest Hill Rd Ste 290, Dallas, TX 75230-5826 | 2012-11-15 |
| 1427330588 | Michael A. Sorace Md Pa | Dermatology | 7950 Floyd Curl Dr Ste 505, Medical Center Tower 1, San Antonio, TX 78229-3924 | 2011-09-15 |
| 1811229180 | Skin Surgery Center, Pa | Dermatology | 6208 Colleyville Blvd, Suite 100, Colleyville, TX 76034-6223 | 2010-02-11 |
| 1265614168 | Michael Sorace | Dermatology | 745 W San Antonio Ave, Suite 100, Boerne, TX 78006-3213 | 2007-12-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.