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General NPI Number Information
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NPI Number | 1821588708
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Entity Type | Organization
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Legal Business Name | FAMILY NURSE PRACTITIONER PROFESSIONALS
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 9 MEDICAL PKWY STE 308
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City | DALLAS
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State | TX
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Zip | 75234-7855
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Country | US
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Telephone | 214-440-6561
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Fax |
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Provider Business Mailing Address
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Address Line | 2813 LAKE VISTA DR
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City | WYLIE
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State | TX
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Zip | 75098-6401
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Country | US
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Telephone | 214-440-6561
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | LAKESHIA EALY
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Credential | FNP-C
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Telephone | 214-440-6561
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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 | AP137442
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License Number State | TX
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