Healthcare Provider Details

I. General information

NPI: 1871206029
Provider Name (Legal Business Name): JENNIFER L CAUGHRON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 JOE RAMSEY BLVD E STE 100
GREENVILLE TX
75401-7856
US

IV. Provider business mailing address

HUNT REGIONAL MEDICAL PARTNERS SPECIALISTS 4211 JOE RAMSEY BLVD E, SUITE 100
GREENVILLE TX
75401-7856
US

V. Phone/Fax

Practice location:
  • Phone: 903-408-5770
  • Fax: 903-408-5779
Mailing address:
  • Phone: 903-408-5770
  • Fax: 903-408-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1100723
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1100723
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: