Provider Demographics
NPI:1093897316
Name:KESSMANN, JENNIFER RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RUTH
Last Name:KESSMANN
Suffix:
Gender:F
Credentials:MD
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 96163
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0126
Mailing Address - Country:US
Mailing Address - Phone:817-912-1289
Mailing Address - Fax:
Practice Address - Street 1:12240 INWOOD RD STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-8007
Practice Address - Country:US
Practice Address - Phone:817-912-1289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6521207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133214007Medicaid
TX133214007Medicaid