Individual
JENNIFER KENT AUTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
7777 FOREST LN STE C833, DALLAS, TX 75230-2591
(972) 566-4591
(972) 566-6679
Mailing address
400 HOWARD RD, WEATHERFORD, TX 76088-7180
(940) 445-5233
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP121046
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288504801
—
TX
01
—
868N64
BLUE CROSS BLUE SHIELD
TX
01
—
AP121046
APRN
TX
Enumeration date
10/21/2011
Last updated
05/06/2019
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