Provider Demographics
NPI:1912097031
Name:DAWSON, JENNIFER L (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 W HIGHWAY 71 STE C
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8351
Mailing Address - Country:US
Mailing Address - Phone:512-394-3905
Mailing Address - Fax:512-394-3905
Practice Address - Street 1:7225 W HIGHWAY 71 STE C
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8351
Practice Address - Country:US
Practice Address - Phone:512-394-3905
Practice Address - Fax:512-394-3905
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01744T363A00000X
MN10407363A00000X
TXPA07670363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA70671OtherWELLMARK BLUE SHIELD
IAQ74117Medicare UPIN
IA70671OtherWELLMARK BLUE SHIELD