Provider Demographics
NPI:1801067053
Name:HENDRIX, JENNIFER (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3822
Mailing Address - Country:US
Mailing Address - Phone:309-346-3416
Mailing Address - Fax:
Practice Address - Street 1:311 BUDDY GANEM
Practice Address - Street 2:STE A
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-3233
Practice Address - Country:US
Practice Address - Phone:361-777-0500
Practice Address - Fax:361-777-2969
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123984207Q00000X
IL125053226390200000X
TXP1550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program