Provider Demographics
NPI:1831107085
Name:MORAN, JENNIFER (ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SONDALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 732031
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2031
Mailing Address - Country:US
Mailing Address - Phone:866-429-6045
Mailing Address - Fax:970-495-8910
Practice Address - Street 1:4650 SIGNAL TREE DR STE 1200
Practice Address - Street 2:
Practice Address - City:TIMNATH
Practice Address - State:CO
Practice Address - Zip Code:80547-4908
Practice Address - Country:US
Practice Address - Phone:970-237-7415
Practice Address - Fax:970-237-7420
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO96033363L00000X
COAPN.0993856-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0429845Medicaid
IAP22972Medicare UPIN
IAI1229Medicare ID - Type Unspecified