Provider Demographics
NPI:1043795495
Name:MEANS, JEREMY ALLEN (NP)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:ALLEN
Last Name:MEANS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W OAKLAWN RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-4033
Mailing Address - Country:US
Mailing Address - Phone:830-569-8940
Mailing Address - Fax:830-569-8320
Practice Address - Street 1:19010 PREIST BLVD
Practice Address - Street 2:
Practice Address - City:LYTLE
Practice Address - State:TX
Practice Address - Zip Code:78052-3486
Practice Address - Country:US
Practice Address - Phone:830-772-9865
Practice Address - Fax:830-772-9821
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX788669163W00000X
TXAP139044363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX788669OtherTXBON