Provider Demographics
NPI:1346238813
Name:GEORGE, JENNIFER (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1601
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:TX
Mailing Address - Zip Code:78358-1601
Mailing Address - Country:US
Mailing Address - Phone:361-729-3388
Mailing Address - Fax:361-729-3388
Practice Address - Street 1:408 N THIRD ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:TX
Practice Address - Zip Code:78358
Practice Address - Country:US
Practice Address - Phone:361-729-3388
Practice Address - Fax:361-729-3388
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX594747363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP0031Medicare ID - Type Unspecified
S29844Medicare UPIN