Provider Demographics
NPI:1285888768
Name:NELSON, JENNY LOUETTA (PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNY
Middle Name:LOUETTA
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:BREYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 20308
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-0308
Mailing Address - Country:US
Mailing Address - Phone:254-537-6868
Mailing Address - Fax:254-537-6869
Practice Address - Street 1:2401 E ST. NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:022-357-4752
Practice Address - Fax:254-537-6001
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06082363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical