Provider Demographics
NPI:1790974632
Name:CHRISTENSEN, JENNIFER COLEMAN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:COLEMAN
Last Name:CHRISTENSEN
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 1:6210 E HIGHWAY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9596
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:15801 W HIGHWAY 71 STE 100
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-2703
Practice Address - Country:US
Practice Address - Phone:512-676-2500
Practice Address - Fax:512-406-7377
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5053208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX312240003Medicaid
TX312240002Medicaid
TX312240003Medicaid
383225YKXYMedicare PIN