=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659516615
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JARRA L GREEN-CALDERON APRN, FNP-C, BC-ADM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2008
-----------------------------------------------------
Last Update Date | 08/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5441 BABCOCK RD STE 203
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78240-3993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-701-8890
-----------------------------------------------------
Fax | 210-783-8840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8428 BANDERA RD STE 2
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78250-2514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-701-8890
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number | 754909
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP143451
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | AP143451
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------