Healthcare Provider Details

I. General information

NPI: 1154742450
Provider Name (Legal Business Name): JENNIFER ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16835 DEER CREEK DR STE. 120
SPRING TX
77379-4968
US

IV. Provider business mailing address

31018 PINE KNOT RD
MAGNOLIA TX
77354-8417
US

V. Phone/Fax

Practice location:
  • Phone: 281-379-4373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number2066451
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: