Provider Demographics
NPI:1164180485
Name:GLENN, JENNY
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:GLENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 COUNTY ROAD 6494
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-3215
Mailing Address - Country:US
Mailing Address - Phone:713-319-8944
Mailing Address - Fax:
Practice Address - Street 1:1201 N TRAVIS ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-3539
Practice Address - Country:US
Practice Address - Phone:936-336-9175
Practice Address - Fax:936-336-8581
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1055119363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care