Basic Information
| Provider Information | |||||||||
| NPI: | 1285787762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARREN | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 907 E HILL ST | ||||||||
| Address2: | |||||||||
| City: | SPUR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793702532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062713306 | ||||||||
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| Practice Location | |||||||||
| Address1: | 907 E HILL ST | ||||||||
| Address2: | |||||||||
| City: | SPUR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793702532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062713306 | ||||||||
| FaxNumber: | 8062714256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 05/09/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 547038 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1093868556 | 01 | TX | RURAL HEALTH CLINIC NPI # | OTHER | 063674801 | 01 | TX | RURAL HEALTH CLINIC TPI # | OTHER | 00081N | 01 | TX | MEDICARE GROUP | OTHER |