Healthcare Provider Details

I. General information

NPI: 1376151118
Provider Name (Legal Business Name): MS. JENNIFER VIRGINIA ANNE WHITLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N STATE HIGHWAY 118
ALPINE TX
79830-2002
US

IV. Provider business mailing address

12701 FM 2657
KEMPNER TX
76539-8099
US

V. Phone/Fax

Practice location:
  • Phone: 432-837-0231
  • Fax: 432-837-0249
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1003955
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: