Basic Information
| Provider Information | |||||||||
| NPI: | 1679015937 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANEY | ||||||||
| FirstName: | JENNY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 W MCDERMOTT DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750133089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725664591 | ||||||||
| FaxNumber: | 9725666679 | ||||||||
| Practice Location | |||||||||
| Address1: | 7777 FOREST LN | ||||||||
| Address2: | SUITE C 833 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752302571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725664591 | ||||||||
| FaxNumber: | 9725666679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2016 | ||||||||
| LastUpdateDate: | 02/27/2019 | ||||||||
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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 | 363LP0808X | AP132637 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | AP132637 | 01 | TX | LICENSE | OTHER | 754917 | 01 | TX | RN- LICENSE | OTHER |