Healthcare Provider Details

I. General information

NPI: 1427405364
Provider Name (Legal Business Name): NORTH TEXAS NEIGHBORHOOD MEDICAL CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 MARTIN LUTHER KING JR BLVD STE C
DALLAS TX
75215-3222
US

IV. Provider business mailing address

1914 SKILLMAN ST STE 110-359
DALLAS TX
75206-8559
US

V. Phone/Fax

Practice location:
  • Phone: 214-425-5935
  • Fax: 972-919-0425
Mailing address:
  • Phone: 214-425-5935
  • Fax: 972-919-0425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DERRICK LOVE-JONES
Title or Position: OWNER
Credential: APRN
Phone: 214-425-5935