Provider Demographics
NPI:1588436653
Name:CONARD, JENNIFER DIANE (CNM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANE
Last Name:CONARD
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 DEEP VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-1926
Mailing Address - Country:US
Mailing Address - Phone:214-403-8316
Mailing Address - Fax:
Practice Address - Street 1:5172 VILLAGE CREEK DR STE 101
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4444
Practice Address - Country:US
Practice Address - Phone:214-597-1526
Practice Address - Fax:214-291-9589
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1082105363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology