Provider Demographics
NPI:1154620417
Name:VALLIERE, JENNIFER LYNNE (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:VALLIERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 ELDORADO PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4273
Mailing Address - Country:US
Mailing Address - Phone:972-548-7888
Mailing Address - Fax:972-562-0781
Practice Address - Street 1:3701 ELDORADO PKWY STE A
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4273
Practice Address - Country:US
Practice Address - Phone:972-562-7888
Practice Address - Fax:972-562-0781
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8358208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics