Provider Demographics
NPI:1316355720
Name:GATES, JENNY R (MSN, APRN,NP-C)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:R
Last Name:GATES
Suffix:
Gender:F
Credentials:MSN, APRN,NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 RIVER PLACE BLVD # 302
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1162
Mailing Address - Country:US
Mailing Address - Phone:512-538-2989
Mailing Address - Fax:
Practice Address - Street 1:6611 RIVER PLACE BLVD # 302
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1162
Practice Address - Country:US
Practice Address - Phone:512-538-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX737232363LP2300X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1316355720Medicaid