Provider Demographics
NPI:1376069260
Name:SCHNEIDER, JENNIE LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:LEE
Last Name:SCHNEIDER
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 844273
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4273
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:1001 N PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751
Practice Address - Country:US
Practice Address - Phone:903-904-5084
Practice Address - Fax:903-904-5085
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134311363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01912502OtherMEDICARE RAIL ROAD
TX8HH255OtherBCBS
TX452578435006OtherTRICARE
TX598706YR7VOtherMEDICARE