Basic Information
| Provider Information | |||||||||
| NPI: | 1073530689 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOTLEY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 ELM ST | ||||||||
| Address2: | |||||||||
| City: | RAWLINS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 823015108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073242221 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4760 BARWICK DR STE C | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173469533 | ||||||||
| FaxNumber: | 8173469788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | TL6447 | WY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | L7491 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 163673001 | 05 | TX | MEDICAID | P00247387 | 01 | RAILROAD MEDICARE | OTHER |