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General NPI Number Information
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NPI Number | 1760971105
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Entity Type | Individual
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Provider Name | JOYCE EBOBOSERE GENTRY FNP-C, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 101 W HAWKINS PKWY STE 1
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City | LONGVIEW
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State | TX
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Zip | 75605-1833
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Country | US
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Telephone | 903-331-0162
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Fax | 903-331-0132
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Provider Business Mailing Address
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Address Line | 101 W HAWKINS PKWY STE 1
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City | LONGVIEW
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State | TX
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Zip | 75605-1833
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Country | US
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Telephone | 903-331-0162
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Fax | 903-331-0132
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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 | AP137345
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP137345
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License Number State | TX
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