Healthcare Provider Details

I. General information

NPI: 1740789924
Provider Name (Legal Business Name): JENNIFER PAULI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SAINT LYNDA DR
MANSFIELD TX
76063-4857
US

IV. Provider business mailing address

7610 N STEMMONS FWY STE 360
DALLAS TX
75247-4231
US

V. Phone/Fax

Practice location:
  • Phone: 817-687-9138
  • Fax:
Mailing address:
  • Phone: 972-203-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberAP136329
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP136329
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: