Provider Demographics
NPI:1447031612
Name:PRIESTLEY, JENNIFER L (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:PRIESTLEY
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 BROWNWAY DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-2203
Mailing Address - Country:US
Mailing Address - Phone:936-520-2657
Mailing Address - Fax:
Practice Address - Street 1:1106 COLLEGE ST STE C
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3948
Practice Address - Country:US
Practice Address - Phone:512-244-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX736525163W00000X
TX1190583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse