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General NPI Number Information
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NPI Number | 1245919356
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Entity Type | Individual
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Provider Name | JESSICA OMOEGBELE MSN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 6464 E NORTHWEST HWY STE 345
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City | DALLAS
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State | TX
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Zip | 75214-7801
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Country | US
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Telephone | 214-613-0973
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Fax |
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Provider Business Mailing Address
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Address Line | 13100 NOEL RD APT 516
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City | DALLAS
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State | TX
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Zip | 75240-0208
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Country | US
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Telephone | 832-305-1773
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1127228
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License Number State | TX
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