MEDICARE: JAMES DANIEL JENNINGS FNP-BC

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	1006030	TX

General Provider Information

NPI Number	:	1326652850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DANIEL JENNINGS FNP-BC

Provider Business Mailing Address
First Line	:	1920 E STATE HIGHWAY 114
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-6510
Country	:	US
Telephone Number	:	817-442-5698
Fax Number	:	817-442-5633

Provider Business Practice Location Address
First Line	:	1920 E STATE HIGHWAY 114
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-6510
Country	:	US
Telephone Number	:	817-442-5698
Fax Number	:	817-442-5633

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

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	09/02/2020

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