Provider Demographics
NPI:1659878304
Name:CULLISON, JENNIFER LYN (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYN
Last Name:CULLISON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4913
Mailing Address - Country:US
Mailing Address - Phone:361-761-1200
Mailing Address - Fax:
Practice Address - Street 1:ST. VINCENT MEDICAL CENTER
Practice Address - Street 2:2213 CHERRY STREET, ACC , 1ST FLOOR
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608
Practice Address - Country:US
Practice Address - Phone:847-445-0928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXT1674207P00000X
OH34.014438207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program