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NPI Code Detail

MEDICARE: MRS. JENNIFER ELISE PADILLA FNP - C

MEDICARE: MRS. JENNIFER ELISE PADILLA 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
1363LF0000XFamily Nurse Practitioner1114730TX

General Provider Information

NPI Number : 1265132682
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER ELISE PADILLA FNP - C
Provider Business Mailing Address
First Line : 515 N 3RD ST
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-6546
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 515 N 3RD ST
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-6546
Country : US
Telephone Number : 903-475-3474
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2023
Last Update Date : 05/18/2026

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