Provider Demographics
NPI:1306610829
Name:NOLLEY, JENNIFER (APRN-CNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:NOLLEY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 RUSHING WAY
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-8138
Mailing Address - Country:US
Mailing Address - Phone:469-585-8088
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN STE C755
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6862
Practice Address - Country:US
Practice Address - Phone:972-566-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1136687363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care