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NPI Code Detail

MEDICARE: JENNIFER WEATHERLY D.O.P.A.

MEDICARE: JENNIFER WEATHERLY D.O.P.A.
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
1363AM0700XMedical Physician AssistantTX

General Provider Information

NPI Number : 1588115455
Entity Type Code : Organization
Provider Name (Legal Business Name) : JENNIFER WEATHERLY D.O.P.A.
Provider Business Mailing Address
First Line : 3250 W PLEASANT RUN RD STE 160
Second Line :
City : LANCASTER
State : TX
Zip : 75146-1071
Country : US
Telephone Number : 972-274-5200
Fax Number :
Provider Business Practice Location Address
First Line : 3250 W PLEASANT RUN RD STE 160
Second Line :
City : LANCASTER
State : TX
Zip : 75146-1071
Country : US
Telephone Number : 972-274-5200
Fax Number :
Authorized Official
Title or Position : PHYSICIAN
Name : JENNIFER WEATHERLY
Credential : D.O.
Telephone Number : 972-274-5200
Provider Enumeration Date : 10/17/2016
Last Update Date : 10/17/2016

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Directions to “JENNIFER WEATHERLY D.O.P.A. ” Practice Location

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