Provider Demographics
NPI:1912634684
Name:RHEA, JENNIFER JADE (APRN)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:JADE
Last Name:RHEA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:1004 W 32ND ST UNIT 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1915
Mailing Address - Country:US
Mailing Address - Phone:512-324-1000
Mailing Address - Fax:512-351-4196
Practice Address - Street 1:1180 SETON PKWY STE 450
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6178
Practice Address - Country:US
Practice Address - Phone:512-504-0860
Practice Address - Fax:512-504-0861
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX880802163W00000X
TX1089294363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17707217OtherTX DL