Healthcare Provider Details

I. General information

NPI: 1902546054
Provider Name (Legal Business Name): JENNIFER ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 WALNUT HILL LN STE 312
DALLAS TX
75231-4419
US

IV. Provider business mailing address

PO BOX 642016
DALLAS TX
75264-2016
US

V. Phone/Fax

Practice location:
  • Phone: 214-238-3074
  • Fax:
Mailing address:
  • Phone: 210-756-5989
  • Fax: 210-568-4064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1073036
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberM4304
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: