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General NPI Number Information
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NPI Number | 1548767197
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Entity Type | Individual
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Provider Name | JAISY RAJU FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 3030 TOWNE CENTRE DR STE 100
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City | MESQUITE
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State | TX
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Zip | 75150-4134
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Country | US
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Telephone | 469-691-2288
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Fax |
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Provider Business Mailing Address
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Address Line | 3030 TOWNE CENTRE DR STE 100
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City | MESQUITE
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State | TX
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Zip | 75150-4134
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Country | US
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Telephone | 469-688-2065
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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 | AP137265
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License Number State | TX
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