Provider Demographics
NPI:1134793573
Name:DENDY, JAZMINE DENISE
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:DENISE
Last Name:DENDY
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:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-1176
Mailing Address - Country:US
Mailing Address - Phone:936-931-3448
Mailing Address - Fax:936-931-3704
Practice Address - Street 1:17330 SPRING CYPRESS RD STE 150
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4295
Practice Address - Country:US
Practice Address - Phone:281-373-3786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036140363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics