MEDICARE: JESSICA A KOINER IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1336008820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA A KOINER IBCLC

Provider Business Mailing Address
First Line	:	4429 SUMMERCREST CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3416
Country	:	US
Telephone Number	:	817-330-4317
Fax Number	:

Provider Business Practice Location Address
First Line	:	4429 SUMMERCREST CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3416
Country	:	US
Telephone Number	:	817-330-4317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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Directions to “ JESSICA A KOINER IBCLC” Practice Location

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