Provider Demographics
NPI:1649608985
Name:HATERIUS, JENNIFER LYNN (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:HATERIUS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-4206
Mailing Address - Country:US
Mailing Address - Phone:806-213-9560
Mailing Address - Fax:806-213-9561
Practice Address - Street 1:901 W CROCKETT ST
Practice Address - Street 2:
Practice Address - City:FLOYDADA
Practice Address - State:TX
Practice Address - Zip Code:79235-3609
Practice Address - Country:US
Practice Address - Phone:806-402-4033
Practice Address - Fax:806-402-4036
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX755706363LF0000X
TXAP124606363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily