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General NPI Number Information
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NPI Number | 1013528884
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Entity Type | Individual
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Provider Name | JEAN DAVI PELLEGALLE APRN, FNP-C, PMHNP-C
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Gender | Male
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 1300 N 6TH ST
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City | LONGVIEW
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State | TX
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Zip | 75601-5567
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Country | US
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Telephone | 903-759-2922
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Fax |
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Provider Business Mailing Address
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Address Line | 7228 COUNTY ROAD 3152
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City | TYLER
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State | TX
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Zip | 75708-6704
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Country | US
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Telephone | 903-539-5745
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP144507
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP144507
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License Number State | TX
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