Provider Demographics
NPI:1316178767
Name:MAXWELL, JENNY (NP)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MEDICAL PKWY
Mailing Address - Street 2:PLAZA 4 STE. 301
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7858
Mailing Address - Country:US
Mailing Address - Phone:972-620-8100
Mailing Address - Fax:972-620-8106
Practice Address - Street 1:9 MEDICAL PKWY
Practice Address - Street 2:PLAZA 4 STE. 301
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7858
Practice Address - Country:US
Practice Address - Phone:972-620-8100
Practice Address - Fax:972-620-8106
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX592056363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty