Provider Demographics
NPI:1306300090
Name:ANDERSON, JAREKA LYNNE (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JAREKA
Middle Name:LYNNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
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Mailing Address - Street 1:601 S CLAY ST
Mailing Address - Street 2:STE 104
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-5771
Mailing Address - Country:US
Mailing Address - Phone:281-221-6605
Mailing Address - Fax:
Practice Address - Street 1:601 S CLAY ST STE 104
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5771
Practice Address - Country:US
Practice Address - Phone:972-875-6600
Practice Address - Fax:877-460-4501
Is Sole Proprietor?:No
Enumeration Date:2019-01-26
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP140317363LA2200X, 363LP0200X, 363LP2300X, 363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health