Healthcare Provider Details

I. General information

NPI: 1114596806
Provider Name (Legal Business Name): FRANCIS LUNA SEGOVIA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 MCKINNEY AVE STE 9
DALLAS TX
75204-8555
US

IV. Provider business mailing address

2821 MCKINNEY AVE STE 9
DALLAS TX
75204-8555
US

V. Phone/Fax

Practice location:
  • Phone: 617-379-0496
  • Fax: 617-379-0434
Mailing address:
  • Phone: 617-379-0496
  • Fax: 617-379-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number801739
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11434-33
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1051685
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: