Individual
LISA FARRY JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
13737 NOEL RD, STE 1400, DALLAS, TX 75240
(972) 715-5000
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
28160032
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
790893
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011251A26
MEDICARE ID
VA
05
—
215319901
—
TX
05
—
215319902
—
TX
01
—
8645UA
BCBS
TX
Enumeration date
05/22/2006
Last updated
06/07/2018
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