MEDICARE: THREE OAKS PALLIATIVE CARE PLLC

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	363LF0000X	Family Nurse Practitioner
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1497377436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE OAKS PALLIATIVE CARE PLLC

Provider Business Mailing Address
First Line	:	717 N HARWOOD ST STE 550
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-6540
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 LAKESIDE BLVD STE 250
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-4351
Country	:	US
Telephone Number	:	877-585-7400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	ANDREA BOHANNON
Credential	:
Telephone Number	:	214-628-9951

Provider Enumeration Date	:	05/13/2020
Last Update Date	:	02/13/2026

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