Provider Demographics
NPI:1982412573
Name:JAENIX, PLLC
Entity type:Organization
Organization Name:JAENIX, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:214-771-2493
Mailing Address - Street 1:1507 WALNUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7296
Mailing Address - Country:US
Mailing Address - Phone:214-771-2493
Mailing Address - Fax:
Practice Address - Street 1:1900 PRESTON RD #345
Practice Address - Street 2:SUITE 24
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:214-771-2493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty