Healthcare Provider Details

I. General information

NPI: 1104650845
Provider Name (Legal Business Name): MONA MARJORIE JEMISON FNP, ENP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N HIGHLAND AVE
SHERMAN TX
75092-7354
US

IV. Provider business mailing address

2624 COUNTY ROAD 156
WHITESBORO TX
76273-6111
US

V. Phone/Fax

Practice location:
  • Phone: 903-870-4611
  • Fax:
Mailing address:
  • Phone: 903-267-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1169647
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: