Provider Demographics
NPI:1750567780
Name:JENNINGS, DEBORAH DENISE
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:DENISE
Last Name:JENNINGS
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 1:619 WENTWORTH DRIVE
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5623
Mailing Address - Country:US
Mailing Address - Phone:972-699-1754
Mailing Address - Fax:
Practice Address - Street 1:619 WENTWORTH DRIVE
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5623
Practice Address - Country:US
Practice Address - Phone:972-699-1754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120746310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility