Healthcare Provider Details

I. General information

NPI: 1295311165
Provider Name (Legal Business Name): JENNIFER L QUIRAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CULLY DR
KERRVILLE TX
78028-5950
US

IV. Provider business mailing address

1307 UHLAND RD
SAN MARCOS TX
78666-8217
US

V. Phone/Fax

Practice location:
  • Phone: 830-258-7400
  • Fax:
Mailing address:
  • Phone: 507-461-1826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1086552
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number7373
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: