Provider Demographics
NPI:1184124067
Name:JENNINGS, LEONDUS D (RN)
Entity type:Individual
Prefix:MR
First Name:LEONDUS
Middle Name:D
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 NORTHLAKE CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-5645
Mailing Address - Country:US
Mailing Address - Phone:469-766-0493
Mailing Address - Fax:469-766-0493
Practice Address - Street 1:2413 NORTHLAKE CT
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-5645
Practice Address - Country:US
Practice Address - Phone:469-766-0493
Practice Address - Fax:469-766-0493
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX928713163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse