Jenniffier Eady, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

P4593 Issued in TX

Practice address

1150 N Kimball Ave Ste 120
Southlake, TX 76092-5570

Phone

(682) 651-8007

Fax

(844) 750-0657

NPI assigned

Jun 15, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jenniffier Eady Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 31, 2022 through Oct 31, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667174400000",
    "number": "1508093733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 WOODLANDS CT",
            "city": "TROPHY CLUB",
            "state": "TX",
            "postal_code": "762629735",
            "telephone_number": "972-310-8872",
            "fax_number": "844-750-0657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N KIMBALL AVE STE 120",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760925570",
            "telephone_number": "682-651-8007",
            "fax_number": "844-750-0657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EADY",
        "first_name": "JENNIFFIER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-15",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "P4593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmahand@radiantprecisionmed.com",
            "affiliation": "N",
            "endpointDescription": "professional email",
            "address_1": "1150 N Kimball Ave Ste 120",
            "city": "Southlake",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760925570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFFIER",
            "last_name": "EADY",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Klyne Duplechian, BCBA
• Aaron James Dupre, MSN, PMHNP-BC
• Maria Duran
• Wesley R Duval, D.C., DACBR
• Kristina Lynn Dyer, LCSW
• Donna Germino Earle, MA., LPC
• Jennine Morgan Earnhardt, D.C
• Ariana Eberhart, RBT
• Ecoutez Southlake LLC
• Hannah Eddy

• Family Medicine Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.