Individual provider Active NPI

Jennifer Renner

  • Nurse Practitioner
  • Wichita Falls, TX
National Provider Identifier
1841611910
Registry record updated May 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
757471 Issued in TX
Practice address
4327 Barnett Rd
Wichita Falls, TX 76310-2303
Phone
(940) 322-6953
Fax
(940) 767-9301
NPI assigned
Dec 17, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 757471 TX Primary

Addresses

Primary practice location

4327 Barnett Rd
Wichita Falls, TX 76310-2303

Mailing address

1 Burnside
Wichita Falls, TX 76310-1123
Phone (940) 322-6953

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170609000531 TX Practitioner - Nurse Practitioner 1153699467 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Head and Neck Surgical AssociatesGroup PAC ID 8022089622, 11 clinicians

Practice addresses (Care Compare)

1 Burnside
Wichita Falls, TX 76310-1123
Phone (940) 322-6953

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
757471TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Head & Neck Surgical Associates CurrentSince Apr 20, 2017 Accepting new patients

Locations

1 Burnside
Wichita Falls, TX 76310
Phone (940) 264-5500

4327 Barnett Rd
Wichita Falls, TX 76310
Phone (940) 761-2922

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1387238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494979200000",
    "number": "1841611910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BURNSIDE",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763101123",
            "telephone_number": "940-322-6953",
            "fax_number": "940-767-9301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4327 BARNETT RD",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763102303",
            "telephone_number": "940-322-6953",
            "fax_number": "940-767-9301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENNER",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-17",
        "last_updated": "2017-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "757471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

Verify at the official NPI Registry.