MEDICARE: JENA LYN RHODES FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP129022	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073983102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENA LYN RHODES FNP

Provider Business Mailing Address
First Line	:	2702 N UNIVERSITY DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2922
Country	:	US
Telephone Number	:	936-585-4130
Fax Number	:	936-585-4134

Provider Business Practice Location Address
First Line	:	4604 NE STALLINGS DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1608
Country	:	US
Telephone Number	:	936-560-5668
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	05/07/2026

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