Healthcare Provider Details

I. General information

NPI: 1497034458
Provider Name (Legal Business Name): JESSICA NICOLE BONIOL MSN, FNP-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA NICOLE DRAIN RN, MSN, FNP-BC

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5148 VILLAGE CREEK DR UNIT 300
PLANO TX
75093-5064
US

IV. Provider business mailing address

213 SPARROW HAWK
MCKINNEY TX
75070-5849
US

V. Phone/Fax

Practice location:
  • Phone: 469-661-1100
  • Fax:
Mailing address:
  • Phone: 469-585-2713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP120667
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number724324
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: