Healthcare Provider Details

I. General information

NPI: 1871269548
Provider Name (Legal Business Name): CORTNEY ROQUEMORE-THOMPSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2021
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 SOUTHWESTERN BLVD APT 3234
DALLAS TX
75214-1542
US

IV. Provider business mailing address

9030 SOUTHWESTERN BLVD APT 3234
DALLAS TX
75214-1542
US

V. Phone/Fax

Practice location:
  • Phone: 254-466-6780
  • Fax:
Mailing address:
  • Phone: 254-466-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1035474
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: