Provider Demographics
NPI:1215474036
Name:CHOATE, JENNIFER JEANNINE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JEANNINE
Last Name:CHOATE
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 1:2808 SHADY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4204
Mailing Address - Country:US
Mailing Address - Phone:580-235-1497
Mailing Address - Fax:
Practice Address - Street 1:2808 SHADY GROVE DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4204
Practice Address - Country:US
Practice Address - Phone:580-235-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX896222163W00000X
OK89982163W00000X
TXAP133159363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse