Provider Demographics
NPI:1457010472
Name:JURACEK, ANJENETTE (MSN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANJENETTE
Middle Name:
Last Name:JURACEK
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4847 WILLIAMS DR STE 109
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-2420
Mailing Address - Country:US
Mailing Address - Phone:737-284-3600
Mailing Address - Fax:903-454-2250
Practice Address - Street 1:4847 WILLIAMS DR STE 109
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-2420
Practice Address - Country:US
Practice Address - Phone:737-284-3600
Practice Address - Fax:903-454-2250
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059430363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty