Healthcare Provider Details
I. General information
NPI: 1811249188
Provider Name (Legal Business Name): JESSICA RENEE MACABU CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 10/10/2012
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
812 US HWY 377 STE 100
ARGYLE TX
76226-4557
US
IV. Provider business mailing address
812 US HWY 377 STE 100
ARGYLE TX
76226-4557
US
V. Phone/Fax
- Phone: 469-405-6638
- Fax:
- Phone: 469-405-6638
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LP0200X |
| Taxonomy | Pediatric Nurse Practitioner |
| License Number | 713024 |
| License Number State | TX |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: