Provider Demographics
NPI:1407460173
Name:DYESS, JENNIFER KAY
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KAY
Last Name:DYESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7349 SIMMONS RD
Mailing Address - Street 2:
Mailing Address - City:DIANA
Mailing Address - State:TX
Mailing Address - Zip Code:75640-3905
Mailing Address - Country:US
Mailing Address - Phone:903-806-4182
Mailing Address - Fax:
Practice Address - Street 1:7349 SIMMONS RD
Practice Address - Street 2:
Practice Address - City:DIANA
Practice Address - State:TX
Practice Address - Zip Code:75640-3905
Practice Address - Country:US
Practice Address - Phone:903-806-4182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345657164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse