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General NPI Number Information
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NPI Number | 1992056816
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Entity Type | Individual
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Provider Name | JOYCE LOUISE KENEBREW APN
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Gender | Female
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 1201 S SHERMAN ST SUITE 201
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City | RICHARDSON
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State | TX
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Zip | 75081-6507
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Country | US
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Telephone | 972-925-9087
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Fax |
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Provider Business Mailing Address
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Address Line | 7251 LAGUNA
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City | GRAND PRAIRIE
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State | TX
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Zip | 75054-0138
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Country | US
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Telephone | 832-549-0984
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 756942
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License Number State | TX
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