MEDICARE: JENNIFER LYNN SPEAKER M.D.

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	207Q00000X	Family Medicine Physician	J6736	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699745166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN SPEAKER M.D.

Provider Business Mailing Address
First Line	:	6100 LAKE WORTH BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3703
Country	:	US
Telephone Number	:	817-237-3321
Fax Number	:	817-237-7970

Provider Business Practice Location Address
First Line	:	6100 LAKE WORTH BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3703
Country	:	US
Telephone Number	:	817-237-3321
Fax Number	:	817-237-7970

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	03/01/2022

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