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General NPI Number Information
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NPI Number | 1285060640
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Entity Type | Individual
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Provider Name | JACKIE SUE GREGORY FNP
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Gender | Female
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 1250 S CAPITAL OF TEXAS HWY BUILDING III SUITE 380
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City | WEST LAKE HILLS
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State | TX
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Zip | 78746-6446
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Country | US
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Telephone | 512-330-3510
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Fax |
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Provider Business Mailing Address
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Address Line | 8426 FALCONET CIR
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City | MCKINNEY
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State | TX
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Zip | 75070-5821
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Country | US
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Telephone | 214-289-2814
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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 | 554539
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License Number State | TX
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