Provider Demographics
NPI:1255941258
Name:FOXWORTH, JENNIFER (RN, FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FOXWORTH
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 SOUTH I-35 E
Mailing Address - Street 2:SUITE 301A
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-1550
Mailing Address - Country:US
Mailing Address - Phone:940-783-5761
Mailing Address - Fax:
Practice Address - Street 1:7912 HUDSON BAY LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-1550
Practice Address - Country:US
Practice Address - Phone:940-206-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX717838163W00000X
TX1018080363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1018080OtherFAMILY NURSE PRACTITIONER
TX717838OtherREGISTERED NURSE LICENSE