Provider Demographics
NPI:1992824791
Name:MOLDENHAUER, JENNIFER LEE (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:MOLDENHAUER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 E HEBRON PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1515
Mailing Address - Country:US
Mailing Address - Phone:972-939-4646
Mailing Address - Fax:972-939-6161
Practice Address - Street 1:1948 E HEBRON PKWY STE 110
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1515
Practice Address - Country:US
Practice Address - Phone:972-939-4646
Practice Address - Fax:972-939-6161
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05046363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant