Basic Information
Provider Information
NPI: 1548502792
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HEMMEGER
FirstName: JENNIFER
MiddleName: MEGAN
NamePrefix: MRS.
NameSuffix:  
Credential: CPNP-AC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SHEPPARD
OtherFirstName: JENNIFER
OtherMiddleName: MEGAN
OtherNamePrefix: MISS
OtherNameSuffix:  
OtherCredential: RN
OtherLastNameType: 1
Mailing Information
Address1: 333 N SANTA ROSA ST
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782073108
CountryCode: US
TelephoneNumber: 2107042011
FaxNumber:  
Practice Location
Address1: 333 N SANTA ROSA ST
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782073108
CountryCode: US
TelephoneNumber: 2107042011
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/25/2013
LastUpdateDate: 03/25/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200X829865TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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