Healthcare Provider Details

I. General information

NPI: 1952801433
Provider Name (Legal Business Name): JULIA NICOLE GREGG PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN STE C528
DALLAS TX
75230-6848
US

IV. Provider business mailing address

7808 CLODUS FIELDS DR
DALLAS TX
75251-2206
US

V. Phone/Fax

Practice location:
  • Phone: 972-770-1032
  • Fax: 469-484-2126
Mailing address:
  • Phone: 972-770-1032
  • Fax: 469-484-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP136465
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: