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Individual
JENNIFER EATHERLY
Active
Individual
JENNIFER EATHERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, APRN, NP-C
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP131104
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200678330A
MEDICAID
OK
05
—
360754101
—
TX
Enumeration date
06/20/2016
Last updated
07/21/2022
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