Provider Demographics
NPI:1659768737
Name:CRAYTON, JENNIFER (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CRAYTON
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:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:5414 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1335
Practice Address - Country:US
Practice Address - Phone:903-581-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127957363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8GF853OtherBCBS
TX355528605Medicaid
TX75-0818167-044OtherTRICARE
TX75-2616977-002OtherTRICARE
TX355528607Medicaid
TX75-0818167-015OtherTRICARE
TX75-1976930-005OtherTRICARE
TX75-2616977-028OtherTRICARE
TX8GF850OtherBCBS
TXP01782063OtherRAIL ROAD MEDICARE
TX355528604Medicaid
TX355528606Medicaid
TX75-2616977-001OtherTRICARE
TX8GF851OtherBCBS
TX8GF852OtherBCBS
TXP01754646OtherRAIL ROAD MEDICARE
TX432098YS6VMedicare PIN
TX432098YS6PMedicare PIN
TX432098YNSXMedicare PIN
TXP01782063OtherRAIL ROAD MEDICARE