Provider Demographics
NPI:1649747676
Name:PIERSON, JENNIFER DAILEEN (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAILEEN
Last Name:PIERSON
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 1:2277 NW MILITARY HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1853
Mailing Address - Country:US
Mailing Address - Phone:210-342-7300
Mailing Address - Fax:
Practice Address - Street 1:2277 NW MILITARY HWY STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1853
Practice Address - Country:US
Practice Address - Phone:210-342-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily