1588641393 NPI number — MS. JENNIFER A MCCLENDON CRNA

Table of content: MS. JENNIFER A MCCLENDON CRNA (NPI 1588641393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588641393 NPI number — MS. JENNIFER A MCCLENDON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLENDON
Provider First Name:
JENNIFER
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588641393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 W. COLORADO BLVD.
Provider Second Line Business Mailing Address:
SUITE 845
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-946-1133
Provider Business Mailing Address Fax Number:
817-877-0350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 W. COLORADO BLVD.
Provider Second Line Business Practice Location Address:
SUITE 845
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-946-1133
Provider Business Practice Location Address Fax Number:
817-877-0350
Provider Enumeration Date:
12/22/2005

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:  240585 , 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)

  • Identifier: 088706904 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171484201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 088706905 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 088706906 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84562U . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com