Healthcare Provider Details

I. General information

NPI: 1285888768
Provider Name (Legal Business Name): JENNY LOUETTA NELSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY BREYER

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 11/08/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E ST. NW
WASHINGTON DC
20037
US

IV. Provider business mailing address

PO BOX 20308
WACO TX
76702-0308
US

V. Phone/Fax

Practice location:
  • Phone: 22-357-4752
  • Fax: 254-537-6001
Mailing address:
  • Phone: 254-537-6868
  • Fax: 254-537-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA06082
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: