=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467046227
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACREE HOLDINGS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2021
-----------------------------------------------------
Last Update Date | 02/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 772 KENSINGTON DR
-----------------------------------------------------
City | ROCKWALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75032-6608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-227-2457
-----------------------------------------------------
Fax | 214-764-0880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3136 HORIZON RD STE 100
-----------------------------------------------------
City | ROCKWALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75032-7808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-227-2457
-----------------------------------------------------
Fax | 214-764-0880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSHUA ACREE
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 972-475-8914
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------