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NPI Code Detail

MEDICARE: JENNIFER WEATHERLY, D.O. P.A

MEDICARE: JENNIFER WEATHERLY, D.O. P.A
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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10076KTOTHERTXBCBS

General Provider Information

NPI Number : 1982614715
Entity Type Code : Organization
Provider Name (Legal Business Name) : JENNIFER WEATHERLY, D.O. P.A
Provider Business Mailing Address
First Line : 3250 W PLEASANT RUN RD STE 160
Second Line :
City : LANCASTER
State : TX
Zip : 75146-1071
Country : US
Telephone Number : 972-274-5200
Fax Number : 972-274-5217
Provider Business Practice Location Address
First Line : 3250 W PLEASANT RUN RD STE 160
Second Line :
City : LANCASTER
State : TX
Zip : 75146-1071
Country : US
Telephone Number : 972-274-5200
Fax Number : 972-274-5217
Authorized Official
Title or Position : PHYSICIAN/OWNER
Name : JENNIFER ANDREA WEATHERLY
Credential : D.O.
Telephone Number : 972-274-5200
Provider Enumeration Date : 08/08/2006
Last Update Date : 02/10/2014

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