Healthcare Provider Details

I. General information

NPI: 1336769819
Provider Name (Legal Business Name): JENNIFER SOTO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MEDI PARK DR STE 1068
AMARILLO TX
79106-2108
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 806-670-9738
  • Fax: 806-375-5057
Mailing address:
  • Phone: 972-997-8000
  • Fax: 972-234-2987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberAP145823
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP145823
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: