Healthcare Provider Details

I. General information

NPI: 1215446760
Provider Name (Legal Business Name): JENNIFER M PURDY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 SARATOGA BLVD STE 200
CORPUS CHRISTI TX
78414-4252
US

IV. Provider business mailing address

PO BOX 846098
DALLAS TX
75284-6098
US

V. Phone/Fax

Practice location:
  • Phone: 361-986-4600
  • Fax:
Mailing address:
  • Phone: 903-606-6400
  • Fax: 903-606-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024175413
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175413
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141802
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP141802
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: