Healthcare Provider Details

I. General information

NPI: 1588641393
Provider Name (Legal Business Name): JENNIFER A MCCLENDON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W. COLORADO BLVD. SUITE 845
DALLAS TX
75208
US

IV. Provider business mailing address

221 W. COLORADO BLVD. SUITE 845
DALLAS TX
75208
US

V. Phone/Fax

Practice location:
  • Phone: 214-946-1133
  • Fax: 817-877-0350
Mailing address:
  • Phone: 214-946-1133
  • Fax: 817-877-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number240585
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: