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General NPI Number Information
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NPI Number | 1073379582
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Entity Type | Organization
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Legal Business Name | J&D INNOVATIONS TRUST
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Dates
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Enumeration Date | 02/22/2024
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 5900 S LAKE FOREST DR STE 300
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City | MCKINNEY
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State | TX
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Zip | 75070-2238
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Country | US
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Telephone | 469-307-2531
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Fax |
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Provider Business Mailing Address
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Address Line | 550 N CENTRAL EXPY UNIT 118
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City | MCKINNEY
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State | TX
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Zip | 75070-0007
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Country | US
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Telephone | 469-307-2531
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DOMIKAH OLATERU-OLAGBEGI
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Credential | NP
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Telephone | 469-307-2531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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