Provider Demographics
NPI:1124786629
Name:ATHERTON, JENNIFER (NP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ATHERTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13130 BLANCO RD APT 604
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2167
Mailing Address - Country:US
Mailing Address - Phone:210-364-6997
Mailing Address - Fax:
Practice Address - Street 1:13130 BLANCO RD APT 604
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2167
Practice Address - Country:US
Practice Address - Phone:210-364-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF12190701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily