Provider Demographics
NPI:1073983102
Name:RHODES, JENA LYN (FNP)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:LYN
Last Name:RHODES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2922
Mailing Address - Country:US
Mailing Address - Phone:936-585-4130
Mailing Address - Fax:936-585-4134
Practice Address - Street 1:2702 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2922
Practice Address - Country:US
Practice Address - Phone:936-585-4130
Practice Address - Fax:936-585-4134
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX352023101Medicaid
TX352023101Medicaid