Provider Demographics
NPI:1508335225
Name:URBAN, JENNIFER A (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:URBAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4822
Mailing Address - Country:US
Mailing Address - Phone:361-664-0145
Mailing Address - Fax:361-664-2248
Practice Address - Street 1:1302 S ST MARYS STREET
Practice Address - Street 2:SUITES A, B, D
Practice Address - City:FALFURRIAS
Practice Address - State:TX
Practice Address - Zip Code:78355-5034
Practice Address - Country:US
Practice Address - Phone:361-325-9404
Practice Address - Fax:361-221-1728
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX392640402Medicaid
TXP02601787OtherMCRR
TX1L5549OtherMEDICARE
TXPENDINGMedicaid