Provider Demographics
NPI:1396867511
Name:SYMMANK, JENNIFER B (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:SYMMANK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:B
Other - Last Name:SAURETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1910 ROSELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4246
Mailing Address - Country:US
Mailing Address - Phone:903-533-0644
Mailing Address - Fax:
Practice Address - Street 1:3201 S LOOP 256 STE 200
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-6913
Practice Address - Country:US
Practice Address - Phone:903-723-0330
Practice Address - Fax:903-729-6674
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5485207Q00000X
TXM6485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X1636OtherBLUE CROSS
TXP01999541OtherMEDICARE RR
TX187135201Medicaid
TX8HD799OtherBCBS TX
TXP00417899OtherRAILROAD MEDICARE
TX8X1636OtherBLUE CROSS