Healthcare Provider Details

I. General information

NPI: 1205509056
Provider Name (Legal Business Name): MRS. RACHEL TEMPLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 W 15TH ST STE 107
PLANO TX
75075-7789
US

IV. Provider business mailing address

14445 SPEARGRASS DR
FRISCO TX
75033-0742
US

V. Phone/Fax

Practice location:
  • Phone: 972-964-7773
  • Fax:
Mailing address:
  • Phone: 318-573-0734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1032498
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: