Provider Demographics
NPI:1093761348
Name:HUSKEY, JENNI L (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNI
Middle Name:L
Last Name:HUSKEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 S FRY RD STE 700
Mailing Address - Street 2:PMB 534
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8103
Mailing Address - Country:US
Mailing Address - Phone:713-858-3524
Mailing Address - Fax:
Practice Address - Street 1:6725 S FRY RD STE 700
Practice Address - Street 2:PMB 534
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8103
Practice Address - Country:US
Practice Address - Phone:713-503-7817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR171086-5367500000X
TX628378367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN101651200Medicaid