Provider Demographics
NPI:1962467068
Name:OGLE, JENNIFER LYNN (PAC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:OGLE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:CHIESL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9090 KATY FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1696
Mailing Address - Country:US
Mailing Address - Phone:832-522-8280
Mailing Address - Fax:
Practice Address - Street 1:9090 KATY FWY STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:832-522-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX323920402Medicaid
616771110OtherUS DEPT OF LABOR
616771105OtherUS DEPT OF LABOR
TX323920405Medicaid
TX1962467068OtherBLUE CROSS BLUE SHIELD
TX8409NDOtherBLUE CROSS BLUE SHIELD
616771101OtherUS DEPT OF LABOR
TX323920401Medicaid
601771109OtherUS DEPT OF LABOR
TXP01258234OtherMEDICARE RR
616771105OtherUS DEPT OF LABOR
601771109OtherUS DEPT OF LABOR
TXP01258234OtherMEDICARE RR
TX323920401Medicaid
TXTXB113646Medicare PIN