Provider Demographics
NPI:1093784464
Name:BEREND, JACQUELINE RENEE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:RENEE
Last Name:BEREND
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:WINDTHORST
Mailing Address - State:TX
Mailing Address - Zip Code:76389-0064
Mailing Address - Country:US
Mailing Address - Phone:940-423-6518
Mailing Address - Fax:940-687-3500
Practice Address - Street 1:1631 11TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4320
Practice Address - Country:US
Practice Address - Phone:940-687-5100
Practice Address - Fax:940-687-3500
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-05-16
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-04-18
Provider Licenses
StateLicense IDTaxonomies
TX661133363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner