Provider Demographics
NPI:1013973478
Name:JENT, JEANNEAN JOY (CRNA)
Entity Type:Individual
Prefix:MS
First Name:JEANNEAN
Middle Name:JOY
Last Name:JENT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:JEANNEAN
Other - Middle Name:JOY
Other - Last Name:HELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:114 SIERRA TRL
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-7022
Mailing Address - Country:US
Mailing Address - Phone:817-734-6446
Mailing Address - Fax:
Practice Address - Street 1:900 17TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2448
Practice Address - Country:US
Practice Address - Phone:580-256-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011461367500000X
FL121295A367500000X
IL041139679367500000X
NMR56982367500000X
OKR0081277367500000X
TX415154367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0887119 02Medicaid
TX85969UOtherBCBS
TX088711911Medicaid
TX8765UCOtherBCBS
TX088711913Medicaid
TXP01069442OtherRAILROAD MEDICARE
TXP01069442OtherRAILROAD MEDICARE
TX8765UCOtherBCBS
TX00C39MMedicare ID - Type Unspecified