Provider Demographics
NPI:1215080015
Name:RODGES, JENNIFER L (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:RODGES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 WESTPORT PKWY # 5-102
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6739
Mailing Address - Country:US
Mailing Address - Phone:817-233-0417
Mailing Address - Fax:817-848-0017
Practice Address - Street 1:670 WESTPORT PKWY # 5-102
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-6739
Practice Address - Country:US
Practice Address - Phone:817-233-0417
Practice Address - Fax:817-848-0017
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP109098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608851OtherREGISTERED NURSE LICENSE