Provider Demographics
NPI:1417488255
Name:GERARD, JENNIFER (FNP-C, IBCLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GERARD
Suffix:
Gender:F
Credentials:FNP-C, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 LONG PRAIRIE ROAD SUITE 744 #546
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:769-287-0219
Practice Address - Street 1:2219 GREENAN DR
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-1108
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:769-287-0219
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM63518363LF0000X
TX10725811163WL0100X
MDAC003690363LF0000X
ID68047363LF0000X
NE113574363LF0000X
FL11013262363LF0000X
IAA162163363LF0000X
TXAP133187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant