Provider Demographics
NPI:1396893780
Name:EVERSON, JENNIFER A (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:EVERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17183 I 45 S STE 610
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3315
Mailing Address - Country:US
Mailing Address - Phone:281-364-9898
Mailing Address - Fax:281-292-0400
Practice Address - Street 1:17183 I 45 S STE 610
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-3315
Practice Address - Country:US
Practice Address - Phone:281-364-9898
Practice Address - Fax:281-292-0400
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7371207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3660816OtherAETNA
TX8M5481OtherBCBS
TX170812501Medicaid
TX8C2242Medicare ID - Type UnspecifiedMEDICARE