Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | J6521 | TX |
NPI | 1093897316 |
---|---|
Provider Name | Dr. Jennifer Ruth Kessmann |
First Address | Southlake, TX 76092-0126 |
Second Address | Dallas, TX 75244-8007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 09/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133214007 | (05) | TX |
F85085 | (02) |