Provider Demographics
NPI:1346511359
Name:GREENEMEIER, JESSICA HOWARD (PA-C)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:HOWARD
Last Name:GREENEMEIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:3410 WORTH ST
Practice Address - Street 2:STE 160
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:214-826-9873
Practice Address - Fax:214-826-2573
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX294803602Medicaid
TXP01043288OtherRAILROAD
TX294803601Medicaid
TXTXB148073Medicare PIN
TX294803601Medicaid