Individual
MRS. JENNIFER SHIVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6020 W PARKER RD, SUITE 200, PLANO, TX 75093-8171
(972) 608-5000
(972) 608-5020
Mailing address
PO BOX 262409, PLANO, TX 75026-2409
(972) 608-5000
(972) 608-5020
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA01964
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA01964
STATE LICENSE
TX
Enumeration date
01/16/2007
Last updated
08/20/2010
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