Provider Demographics
NPI:1598529893
Name:TOWN, JERILYN KAY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JERILYN
Middle Name:KAY
Last Name:TOWN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JERILYN
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13914 PALATINE HL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-7005
Mailing Address - Country:US
Mailing Address - Phone:330-727-1037
Mailing Address - Fax:
Practice Address - Street 1:22325 GOSLING RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-4409
Practice Address - Country:US
Practice Address - Phone:281-724-7980
Practice Address - Fax:281-547-7911
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151735363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty