Provider Demographics
NPI:1639282031
Name:SCHMITTAUER, JENNIFER LYN (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:SCHMITTAUER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:54 CHAMOMILE CT
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2689
Mailing Address - Country:US
Mailing Address - Phone:281-684-6022
Mailing Address - Fax:
Practice Address - Street 1:3251 I H 45 N
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2185
Practice Address - Country:US
Practice Address - Phone:936-441-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP36741Medicare UPIN
TX8K0327Medicare PIN