1043568660 NPI number — JENNIFER JENKINS LEUELLEN CRNA

Table of content: JENNIFER JENKINS LEUELLEN CRNA (NPI 1043568660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043568660 NPI number — JENNIFER JENKINS LEUELLEN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEUELLEN
Provider First Name:
JENNIFER
Provider Middle Name:
JENKINS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JENKINS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
ASHLEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043568660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1002 GEMINI ST STE 128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77058-2746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-348-0426
Provider Business Mailing Address Fax Number:
281-348-0476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 GEMINI ST STE 128
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77058-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-218-9515
Provider Business Practice Location Address Fax Number:
281-218-9534
Provider Enumeration Date:
08/29/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  147865 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 825414 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)