Provider Demographics
NPI:1710977145
Name:HENNESSEE, JENNIFER GAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:GAYE
Last Name:HENNESSEE
Suffix:
Gender:F
Credentials:MD
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 1266
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78156-1266
Mailing Address - Country:US
Mailing Address - Phone:830-379-0299
Mailing Address - Fax:830-401-0323
Practice Address - Street 1:105 MEDICAL
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5392
Practice Address - Country:US
Practice Address - Phone:830-379-0299
Practice Address - Fax:830-401-0323
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1754207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177185901Medicaid
TX177185901Medicaid
8F1215Medicare PIN