Lynn Karin Jennings, M.D.
Individual provider Active NPI Family Medicine Physician · Gladewater, TX
NPI 1528075124 · NPPES record last updated Aug 13, 2014
Key facts
- NPI
- 1528075124
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- J7528 (TX)
- Practice address
- 1600 Broadway Ave
Gladewater, TX 75647-5040 - Phone
- (903) 315-5630
- Fax
- (903) 845-6212
- NPI assigned
- Aug 3, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170228000995 | LA | Order and Referring Only - Family Practice |
5890778534 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Icw Ta | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | J7528 | TX | Yes |
Addresses
Primary practice location
1600 Broadway Ave
Gladewater, TX 75647-5040
Mailing address
PO Box 4207
Longview, TX 75606-4207
Phone (903) 315-4119
Other providers in Gladewater, TX
- Nicole Hatfield
- Walter Mark Henry
- William Hollas
- Holly Dental PLLC
- Gregory Stephen Jeffers
- Joken Inc
- Kcam Consulting
- Kala Brown Kegarise
- L-M-R Health Care Services Inc
- Iesha Michelle Lane
All providers in Gladewater, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.