Healthcare Provider Details

I. General information

NPI: 1750513149
Provider Name (Legal Business Name): JENNIFER ELIZABETH PARIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11805 SOUTH FWY STE 201
BURLESON TX
76028-7220
US

IV. Provider business mailing address

800 W MAGNOLIA AVE
FORT WORTH TX
76104-4611
US

V. Phone/Fax

Practice location:
  • Phone: 817-333-0133
  • Fax: 817-882-8053
Mailing address:
  • Phone: 817-333-0133
  • Fax: 817-882-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA06369
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: