Individual provider Active NPI

Katherine Ann Jennings, FNP-C

  • Family Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1891245908
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP132242 Issued in TX
Practice address
5414 S Broadway Ave
Tyler, TX 75703-1335
Phone
(903) 581-1601
NPI assigned
Oct 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP132242 TX
Family Nurse Practitioner 363LF0000X AP132242 TX Primary

Addresses

Primary practice location

5414 S Broadway Ave
Tyler, TX 75703-1335

Mailing address

800 E Dawson St
Tyler, TX 75701-2036

Other practice location 1

1000 S Beckham Ave
Tyler, TX 75701-1908
Phone (903) 596-3159

Other practice location 2

3203 S Main St
Lindale, TX 75771-7727
Phone (903) 266-4000

Other practice location 3

3593 E Grande Blvd
Tyler, TX 75707-1400
Phone (903) 839-2585

Other practice location 4

1339 S Broadway St
Sulphur Springs, TX 75482-4895
Phone (903) 952-1001

Other practice location 5

520 Douglas Blvd
Tyler, TX 75702-8307
Phone (903) 606-6400

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
I20161209001307 TX Practitioner - Nurse Practitioner 3577843408 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians
Mother Frances Hospital Regional Health Care CenterGroup PAC ID 9234025636, 120 clinicians

Practice addresses (Care Compare)

3593 E Grande Blvd
Christus Trinity Clinic
Tyler, TX 75707-1400
Phone (903) 839-2585

5414 S Broadway Ave
Christus Mother Frances Hospital
Tyler, TX 75703-1335
Phone (903) 531-5010

620 S Fleishel Ave
Christus Trinity Clinic
Tyler, TX 75701-2041
Phone (903) 606-4900

630 S Fleishel Ave
Tyler, TX 75701-2041
Phone (903) 606-5560

800 E Dawson St
Tyler, TX 75701-2036

PO Box
Suite 846098
Dallas, TX 75284-6098

Hospital & facility affiliations

  • Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Etmc Physician Group Inc. CurrentSince Apr 16, 2018 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Dec 6, 2021 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jan 8, 2022 Accepting new patients
Etmc Physician Group Inc. CurrentSince Apr 16, 2018 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jan 8, 2022 Accepting new patients
Mother Frances Hospital Past Accepting new patients

Locations

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

3203 S Main St
Lindale, TX 75771
Phone (903) 266-4000

1339 S Broadway St
Sulphur Springs, TX 75482
Phone (903) 951-1000

3593 E Grande Blvd
Tyler, TX 75707
Phone (903) 606-1664

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

520 Douglas Blvd
Tyler, TX 75702
Phone (903) 510-1175

5414 S Broadway Ave
Tyler, TX 75703
Phone (903) 581-1601

1000 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-1068

6210 S Broadway Ave
Tyler, TX 75703
Phone (903) 579-2700

11937 US Highway 271
Tyler, TX 75708
Phone (903) 877-3451

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

Organizations & group practices 6

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

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": "1476230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1891245908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E DAWSON ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5414 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031335",
            "telephone_number": "903-581-1601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 S Beckham Ave",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757011908",
            "country_code": "US",
            "telephone_number": "903-596-3159",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3203 S Main St",
            "address_purpose": "LOCATION",
            "city": "Lindale",
            "state": "TX",
            "postal_code": "757717727",
            "country_code": "US",
            "telephone_number": "903-266-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3593 E Grande Blvd",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757071400",
            "country_code": "US",
            "telephone_number": "903-839-2585",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1339 S Broadway St",
            "address_purpose": "LOCATION",
            "city": "Sulphur Springs",
            "state": "TX",
            "postal_code": "754824895",
            "country_code": "US",
            "telephone_number": "903-952-1001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "520 Douglas Blvd",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757028307",
            "country_code": "US",
            "telephone_number": "903-606-6400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENNINGS",
        "first_name": "KATHERINE",
        "middle_name": "ANN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-12",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP132242",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP132242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.