Healthcare Provider Details

I. General information

NPI: 1902458516
Provider Name (Legal Business Name): JUANITA PRICE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2019
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 S HAMPTON RD
DALLAS TX
75232-1058
US

IV. Provider business mailing address

4323 S HAMPTON RD
DALLAS TX
75232-1058
US

V. Phone/Fax

Practice location:
  • Phone: 214-331-6534
  • Fax: 214-433-3046
Mailing address:
  • Phone: 214-331-6534
  • Fax: 214-433-3046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141914
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: