Provider Demographics
NPI:1740798917
Name:WALL, JENNIFER N (MSN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:N
Last Name:WALL
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:N
Other - Last Name:HUNLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:8015 SHOAL CREEK BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8051
Mailing Address - Country:US
Mailing Address - Phone:512-467-7246
Mailing Address - Fax:512-467-7247
Practice Address - Street 1:8015 SHOAL CREEK BLVD STE 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8051
Practice Address - Country:US
Practice Address - Phone:512-467-7246
Practice Address - Fax:512-467-7247
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX834460163W00000X
TXAP136233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse