MEDICARE: NRS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1063969459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NRS, INC

Provider Business Mailing Address
First Line	:	1914 SKILLMAN ST
Second Line	:	STE 110-359
City	:	DALLAS
State	:	TX
Zip	:	75206-8559
Country	:	US
Telephone Number	:	214-425-5935
Fax Number	:	972-919-0425

Provider Business Practice Location Address
First Line	:	1705 MARTIN LUTHER KING JR BLVD STE C
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-3223
Country	:	US
Telephone Number	:	214-425-5935
Fax Number	:	972-919-0425

Authorized Official
Title or Position	:	OWNER
Name	:	DERRICK JONES
Credential	:
Telephone Number	:	214-425-5935

Provider Enumeration Date	:	09/02/2016
Last Update Date	:	09/02/2016

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