Healthcare Provider Details

I. General information

NPI: 1942064670
Provider Name (Legal Business Name): JENNIFER LENAE HURT-FRAZIER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 N PACIFIC ST
MINEOLA TX
75773-1054
US

IV. Provider business mailing address

15956 MCELROY RD
WHITEHOUSE TX
75791-8335
US

V. Phone/Fax

Practice location:
  • Phone: 903-569-6124
  • Fax:
Mailing address:
  • Phone: 903-363-3526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1148560
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: