MEDICARE: MRS. JENNIFER LYNN LIGON-GASTON FNP-C

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	363LF0000X	Family Nurse Practitioner	AP131237	TX

General Provider Information

NPI Number	:	1780037861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LYNN LIGON-GASTON FNP-C

Provider Business Mailing Address
First Line	:	19782 HIGHWAY 105 W
Second Line	:	SUITE 111
City	:	MONTGOMERY
State	:	TX
Zip	:	77356-3103
Country	:	US
Telephone Number	:	936-582-0220
Fax Number	:	936-582-0222

Provider Business Practice Location Address
First Line	:	19782 HIGHWAY 105 W
Second Line	:	SUITE 111
City	:	MONTGOMERY
State	:	TX
Zip	:	77356-3103
Country	:	US
Telephone Number	:	936-582-0220
Fax Number	:	936-582-0222

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

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/13/2016

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