Provider Demographics
NPI:1811391493
Name:DAILEY, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 WORTH ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2003
Mailing Address - Country:US
Mailing Address - Phone:214-820-6856
Mailing Address - Fax:214-820-1474
Practice Address - Street 1:3410 WORTH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:214-820-6856
Practice Address - Fax:214-820-1474
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126621363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3411357-01Medicaid
TX3411357-01Medicaid