| Jennifer Andrea Weatherly, DO | |
|
2424 W Pleasant Run Rd Ste 200, Lancaster, TX 75146-4007 | |
| (972) 274-5200 | |
| (972) 274-5217 |
| Full Name | Jennifer Andrea Weatherly |
|---|---|
| Gender | Female |
| Speciality | Family Medicine |
| Location | 2424 W Pleasant Run Rd Ste 200, Lancaster, Texas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548279375 | NPI | - | NPPES |
| 395294701 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | L3871 (Texas) | Primary |
| Entity Name | Conviva Medical Center Management Of Texas, P.a. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1770988990 PECOS PAC ID: 8729302278 Enrollment ID: O20150112000488 |
| Mailing Address | Practice Location Address |
|---|---|
| Jennifer Andrea Weatherly, DO 2424 W Pleasant Run Rd Ste 200, Lancaster, TX 75146-4007 Ph: (972) 274-5200 | Jennifer Andrea Weatherly, DO 2424 W Pleasant Run Rd Ste 200, Lancaster, TX 75146-4007 Ph: (972) 274-5200 |
Brian Rogers, DO Family Medicine Medicare: May Accept Medicare Assignments Practice Location: 2700 W Pleasant Run Rd Ste 320, Lancaster, TX 75146 Phone: 469-272-6256 Fax: 469-526-5650 | |
Jon R Gonzalez, DO Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2424 W Pleasant Run Rd Ste 200, Lancaster, TX 75146 Phone: 972-274-5200 Fax: 972-274-5217 |