MEDICARE: JENNIFER LANETTE CAIN MSN, APRN, FNP-C

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	AP144041	TX

General Provider Information

NPI Number	:	1174168942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LANETTE CAIN MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 848476
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-8476
Country	:	US
Telephone Number	:	254-202-4655
Fax Number	:	254-202-4697

Provider Business Practice Location Address
First Line	:	9821 CHINA SPRING RD
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-4800
Country	:	US
Telephone Number	:	254-202-7400
Fax Number	:

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

Provider Enumeration Date	:	11/15/2019
Last Update Date	:	09/01/2020

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