Healthcare Provider Details

I. General information

NPI: 1245126366
Provider Name (Legal Business Name): JOANNA YUAN LY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 PRAIRIE DR STE 102
PROSPER TX
75078-3818
US

IV. Provider business mailing address

1613 ALEXANDER DR
MCKINNEY TX
75071-4168
US

V. Phone/Fax

Practice location:
  • Phone: 972-544-9455
  • Fax: 972-544-9465
Mailing address:
  • Phone: 510-381-6683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1142693
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1142693
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: