Healthcare Provider Details

I. General information

NPI: 1780335273
Provider Name (Legal Business Name): KATHRYN JEURISSEN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2022
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 SLEEPY HOLLOW LN
TEMPLE TX
76502-7146
US

IV. Provider business mailing address

25360 COUNTY ROUTE 16
EVANS MILLS NY
13637-3104
US

V. Phone/Fax

Practice location:
  • Phone: 402-540-2097
  • Fax:
Mailing address:
  • Phone: 402-540-2097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF349035
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1141791
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: