Provider Demographics
NPI:1285616664
Name:HAGGARD, JENNY ILENE (ACNP,FNP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:ILENE
Last Name:HAGGARD
Suffix:
Gender:F
Credentials:ACNP,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3043 GESSNER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080
Mailing Address - Country:US
Mailing Address - Phone:713-202-1544
Mailing Address - Fax:
Practice Address - Street 1:4201 GARTH RD
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3167
Practice Address - Country:US
Practice Address - Phone:281-420-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251223363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042493904Medicaid
TXS86491Medicare UPIN
TX042493904Medicaid