Provider Demographics
NPI:1962657015
Name:MAUPIN, JENNIFER MARIE (MS, RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:MAUPIN
Suffix:
Gender:F
Credentials:MS, RN, CPNP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:NECHETSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6701 FANNIN ST
Mailing Address - Street 2:CCC 1720.11
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2316
Mailing Address - Country:US
Mailing Address - Phone:832-822-3665
Mailing Address - Fax:832-825-1707
Practice Address - Street 1:6701 FANNIN ST
Practice Address - Street 2:CCC 1720.11
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2316
Practice Address - Country:US
Practice Address - Phone:832-822-3665
Practice Address - Fax:832-825-1707
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX696056363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11453724OtherPPO NEXT
TX199878302OtherCOMMUNITY HEALTH CHOICE
TX8314543OtherCIGNA
TX3018341OtherUNITED HEALTH CARE
TX199878302Medicaid
TX9310350OtherAETNA
TXMA08Y9410OtherBLUE CROSS/BLUE SHIELD PROVIDER NUMBER
TX2619479OtherBEECH STREET
TX199878302Medicaid