Provider Demographics
NPI:1326323353
Name:AUTRY, JENNIFER KENT (PMHNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KENT
Last Name:AUTRY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HOWARD RD
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76088-7180
Mailing Address - Country:US
Mailing Address - Phone:940-445-5233
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN STE C833
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2591
Practice Address - Country:US
Practice Address - Phone:972-566-4591
Practice Address - Fax:972-566-6679
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121046363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP121046OtherAPRN
TX868N64OtherBLUE CROSS BLUE SHIELD
TX288504801Medicaid