Provider Demographics
NPI:1851021752
Name:HANEY, JENNA RIVERA (DO)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:RIVERA
Last Name:HANEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:520 DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8307
Mailing Address - Country:US
Mailing Address - Phone:903-606-1721
Mailing Address - Fax:903-525-1230
Practice Address - Street 1:520 DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8307
Practice Address - Country:US
Practice Address - Phone:903-606-1721
Practice Address - Fax:903-525-1230
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV7900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine