Provider Demographics
NPI:1265701841
Name:MEADERS, JENNIFER M (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MEADERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:WOODWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 GERLAND WAGNER RD
Mailing Address - Street 2:
Mailing Address - City:CARMINE
Mailing Address - State:TX
Mailing Address - Zip Code:78932-5235
Mailing Address - Country:US
Mailing Address - Phone:832-741-4271
Mailing Address - Fax:
Practice Address - Street 1:1910 NIEBUHR ST
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5037
Practice Address - Country:US
Practice Address - Phone:979-353-4267
Practice Address - Fax:979-836-5863
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121248363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX291438401Medicaid
TX869N77OtherBCBS
TX291438401Medicaid