Healthcare Provider Details

I. General information

NPI: 1760849558
Provider Name (Legal Business Name): PRIMARY CARE SOLUTIONS OF TEXAS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 SKILLMAN ST STE 110-359
DALLAS TX
75206-7954
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP125430
License Number StateTX

VIII. Authorized Official

Name: DERRICK LOVE-JONES
Title or Position: OWNER
Credential: AGPCNP-BC
Phone: 469-660-6767