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General NPI Number Information
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NPI Number | 1518777275
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Entity Type | Individual
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Provider Name | JENNIFER WILD CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 1000 S BECKHAM AVE
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City | TYLER
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State | TX
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Zip | 75701-1908
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Country | US
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Telephone | 903-597-0351
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Fax |
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Provider Business Mailing Address
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Address Line | 6225 N STATE HIGHWAY 161 STE 200
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City | IRVING
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State | TX
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Zip | 75038-2241
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Country | US
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Telephone | 214-687-0001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 152875
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License Number State | TX
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