Provider Demographics
NPI:1508093733
Name:EADY, JENNIFFIER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFFIER
Middle Name:
Last Name:EADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFFIER
Other - Middle Name:
Other - Last Name:EADY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5 WOODLANDS CT
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-9735
Mailing Address - Country:US
Mailing Address - Phone:972-310-8872
Mailing Address - Fax:844-750-0657
Practice Address - Street 1:1150 N KIMBALL AVE STE 120
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-5570
Practice Address - Country:US
Practice Address - Phone:682-651-8007
Practice Address - Fax:844-750-0657
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine