Provider Demographics
NPI:1194728535
Name:YORK, JENNIFER (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:YORK
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 1:5750 BALCONES DR
Mailing Address - Street 2:STE 110
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4252
Mailing Address - Country:US
Mailing Address - Phone:512-744-0015
Mailing Address - Fax:512-744-1654
Practice Address - Street 1:5750 BALCONES DR
Practice Address - Street 2:STE 110
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4252
Practice Address - Country:US
Practice Address - Phone:512-744-0015
Practice Address - Fax:512-744-1654
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ60542084N0600X, 2084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG71260Medicare UPIN
TX8D1256Medicare PIN
TX6320490001Medicare NSC
TX00112YMedicare ID - Type Unspecified