Provider Demographics
NPI:1760030100
Name:CARREON, JENNIFER KATHRYN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KATHRYN
Last Name:CARREON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KATHRYN
Other - Last Name:EBELING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:ATTN BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4587
Mailing Address - Country:US
Mailing Address - Phone:806-351-7530
Mailing Address - Fax:806-351-7538
Practice Address - Street 1:1411 E AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-5555
Practice Address - Country:US
Practice Address - Phone:806-351-7200
Practice Address - Fax:806-351-7274
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1A9386OtherMEDICARE
TX4110488-01Medicaid
TX1W2796OtherPTAN